Prof Pieter Sonneveld (University Hospital Rotterdam, Netherlands) chairs a roundtable discussion for ecancer at the 16th International Myeloma Workshop in Delhi, India.
Focusing on newly diagnosed multiple myeloma (NDMM) and the management of bone disease, he is joined by Prof Michele Cavo (Seràgnoli Institute of Hematology, Bologna, Italy), Dr Peter Voorhees (Levine Cancer Institute, North Carolina, USA) and Professor Evangelos Terpos (University of Athens, Greece).
First discussed was the treatment of symptomatic transplant-eligible multiple myeloma patients, with Prof Cavo suggesting that although trials continue to explore old and new agents, high dose melphalan supported by ASCT should remain the standard of care for the treatment of fit NDMM patients.
Trials assessing these agents were discussed, such as the StaMINA trial presented at ASH 2016, which showed that the addition of bortezomib, lenalidomide (Len) and dexamethasone (RVD) consolidation or a second Autologous Hematopoietic Cell Transplant (autoCHT) was not superior to a single autoHCT followed by Len maintenance in the upfront treatment of MM.
Moving on to asymptomatic patients, Dr Voorhees provided an overview of the treatment of smoldering myeloma (SM). Discussion focused on the evolving therapeutic landscape in SM, with agents such as elotuzumab and checkpoint inhibitors pembrolizumab and nivolumab showing promise.
Proteasome inhibition was also discussed, looking at the CESAR and ASCENT trials, with Dr Voorhees commenting that with the latter it will be “interesting to see if this leads to cure”.
The panel then focussed on the management of bone disease – the most common complication of multiple myeloma with 80% of patients presenting with detectable lesions.
Bisphosphonates such as zoledronic acid are the current mainstay for the treatment of myeloma bone disease, with several novel agents, including denosumab, showing positive results.
These advances show that for NDMM patients the future is promising for both first-line treatment options and the management of common complications.
This programme has been supported by an unrestricted educational grant from Janssen Pharmaceuticals (A Johnson & Johnson Company).