Innovative agents in multiple myeloma

Abstract

Multiple myeloma (MM) remains an incurable cancer of the bone marrow plasma cells. However, the overall survival of patients with MM has increased dramatically within the past decade. This is due, in part, to newer agents such as immunomodulatory drugs (lenalidomide, thalidomide, and pomalidomide) and proteasome inhibitors (bortezomib, carfilzomib, MLN9708). These and several other new classes of drugs have arisen from an improved understanding of the complex environment in which genetic changes occur. Improved understanding of genetic events will enable clinicians to better stratify risk before and during therapy, tailor treatment, and test the value of personalized interventions. The ultimate goal in this incurable disease setting is to reduce the impact of cancer- or chemotherapy-related side effects. Nurses and advanced practitioners are integral to the treatment team. Thus, each should be aware of changes to the current drug landscape. Targeted drugs with sophisticated mechanisms of action are currently under investigation. Patients gain access to newer drugs within the context of clinical trials. Awareness of such trials will help accrual and determine if therapeutic benefit exists. In this article, we will describe new agents with unique and targeted mechanisms of action that have activity in patients with relapsed and/or refractory multiple myeloma.

Figure 1

Cellular and signaling interactions between the multiple myeloma cell and the bone marrow microenvironment. HDAC = histone deacetylase; HGF = hepatocyte growth factor; IL = interleukin; MoAbs = monoclonal antibodies; OPG = osteoprotegerin; RANKL = receptor activator of nuclear factor kappa B; TNF = tumor necrosis factor; VEGF = vascular endothelial growth factor.

Table 1

Clinical Trials Investigating Key Monoclonal Antibodies in Multiple Myeloma