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. 2020 Nov 24;11(47):4371-4386.
doi: 10.18632/oncotarget.27819.

Treatment of elderly patients with refractory/relapsed multiple myeloma: oral drugs adherence and the COVID-19 outbreak

Flávia Dias Xavier  1   2 , Fernando Sergio Blumm Ferreira  2 , Rodrigo Martins Abreu  3
Affiliations

Treatment of elderly patients with refractory/relapsed multiple myeloma: oral drugs adherence and the COVID-19 outbreak

Flávia Dias Xavier et al. Oncotarget. .

Abstract

Once the treatment of refractory/relapsed multiple myeloma in the elderly is greatly influenced by the adherence of patients and family members, clinicians should be aware of patients' behavior and lifestyle, as it may influence the individual treatment plan for each patient. Furthermore, treatment with oral chemotherapy is of special value during the COVID-19 outbreak. Multidisciplinary healthcare involvement is crucial in the management of polypharmacy, adverse events and dose adjustment due to comorbidities and natural loss of renal function with age. Oral drugs simplify intake, reduce hospital visits, and improve autonomy and quality of life. However, although oral drugs have advantages, they also transfer control and responsibility from the healthcare professional to the patient, who must be able to understand and follow the directions given. Therefore, patient education and communication with healthcare professionals are critical for adherence.

Keywords: adherence; elderly; healthcare; multiple myeloma; refractory/relapsed.

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Conflict of interest statement

CONFLICTS OF INTEREST Flávia Dias Xavier has received fees for serving as an advisory board member for Amgen and Janssen, for serving as a speaker for Janssen, Amgen and Takeda and for preparing medical presentations for Takeda. Rodrigo Martins Abreu is Scientific Medical Manager in Medical Affairs at Takeda Distribuidora Ltd, Brazil. Fernando Sergio Blumm Ferreira report no conflicts of interest in this work.

Figures

Figure 1
Figure 1. Definitions [11, 85].
Figure 2
Figure 2. Evolution of MM treatment in the US.
Gray = year of approval in Brazil. Black = alkylating agents. Red = corticosteroids. Green = immunomodulators. Purple = proteasome inhibitors. Orange = monoclonal antibodies. Blue = histone deacetylase inhibitor. auto-SCT = autologous hematopoietic stem cell transplantation. Dark blue = selective inhibitor of the nuclear export protein exportin 1 (XPO1). Oral or intravenous drugs: melphalan and dexamethasone. Oral drugs only: prednisone, thalidomide, lenalidomide, pomalidomide, ixazomib, panabinostat and selinexor. Intravenous only: Carfilzomib and elotozumab. Intravenous or subcutaneous: bortezomibe and daratumumab.
Figure 3
Figure 3. Relevant factors in the therapeutic choice and oral chemotherapy [7].
Figure 4
Figure 4. Barriers to adherence and strategies for adherence to oral chemotherapy [65, 66].
Some items in the table are based on our experience.
Figure 5
Figure 5. Proposed algorithm to treat early, intermediate and advanced disease (based on the number of previous lines).
*In Brazil, pomalidomide is not available (PCd, KPd, DPd, VPd and Pd are alternative options). IRd and ERd have a significant effect on PFS in patients with second and third previous lines not refractory to lenalidomide and preferably sensitive to bortezomib [–15, 31, 86]. Patients who relapse after ≥ 2 years are considered sensitive.
See this image and copyright information in PMC

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