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Ever-Emerging Treatment Paradigms for Myeloma

Thursday, April 13, 2017


Charise Gleason, MSN, NP-BC, AOCNP:
We’ve seen quite a few changes in myeloma with all of these new agents that we have to offer, and patients are living longer. In fact, 10 years ago, when you gave a patient a diagnosis, they had 3 to 5 years at that point and still somewhat limited options. And now patients are living 7 to 10 years and longer because of all these new agents that we have available to us. So, with the addition of monoclonal antibodies, we can now offer a way to make patients’ current therapies better, but also give them new options. Immune therapy is really the direction where we’re going with the new therapies that we’re using in clinical trials now. We already know, based on the data, that 3 drugs in an induction, for instance, are superior. Now we’re adding a monoclonal antibody to that on clinical trials to see, is 4 drugs better? And we’ll have that data in the next year. Monoclonal antibodies are just easy drugs to use because you can add them on easily and, again, they’re so well-tolerated for patients.

Wendy Vogel, MSN, FNP, AOCNP: The future for multiple myeloma is so bright now. It’s so exciting. I’ve been in oncology, as a nurse practitioner, for almost 20 years and to see how far we’ve come is so exciting. We’ve seen that monoclonal antibody therapy works so well in other diseases, and this is a first now in multiple myeloma. We tried some previous things like rituximab, and even though CD20 is a target that we see expressed on myeloma cells, we haven’t found that that was very effective in treatment of myeloma. Now we have 2 targeted agents. One targets CS1, or SLAM F7, and one targets CD38. So, this is really exciting now that myeloma has its very own monoclonal antibodies with a whole different side effect profile that’s often much easier tolerated, and we’re seeing great results with patients in this disease. The future is even brighter because there are lots of different targets that we’re looking at now in research—different targets where we’re going to see more monoclonal antibody therapy emerge.

Kathleen Colson, RN, BSN, BS: In my view, how has the treatment for multiple myeloma changed? The therapeutic landscape for multiple myeloma has changed dramatically over the last 15 to 16 years. This is due to having the introduction of novel agents looking at proteasome inhibitors and immunomodulatory drugs. And now what’s so exciting is that we have monoclonal antibodies to add in to the mix, which translates to certainly having better responses for patients, more treatment options for these patients, better responses for their disease, and a much better quality of life.

Our myeloma patients are very smart, and they’re very in tune to all of the new discoveries that have happened with myeloma, the monoclonal antibodies, with all these novel agents. And so, their experience is very positive because they know that research is continuing. We certainly have made huge strides, but we have a long way to go for our patients. The experience has changed. We have so many new oral therapies. And so, patients have better control of their lives that they can take oral medications and they can take these medications at home. Also, they’re excited that with monoclonal antibodies, their own immune system is now attacking their cancer cells.

And with these monoclonal antibodies, patients come in weekly for the first couple of months and then, usually, it’s just twice weekly. So, again, they’re not always having to come into clinic for therapies. And these are like biological therapies. They’re not the old standard chemotherapies that have many, many side effects. All the side effects with these drugs that patients are generally experiencing are very tolerable. They’re generally mild and easily managed.

Wendy Vogel, MSN, FNP, AOCNP: The patient experience has changed in myeloma, I think, a lot with regard to side effects. The first one that comes to mind would be peripheral neuropathy, which is so prevalent in the myeloma population and with the therapies we traditionally use. That is something that we probably are not going to see a whole lot of in monoclonal antibody therapy. So, I think that, in terms of the patient perspective, we’re going to see better tolerance, better acceptance, and hopefully living much longer.

Charise Gleason, MSN, NP-BC, AOCNP: The patient experience has changed in that they have more options with so many therapies, and we’re now able to give patients a choice. You can lay out 2 or 3 regimens to a patient, explain each one, and make them part of the conversation. It isn’t just us telling the patient how we’re going to treat them. And so, with monoclonal antibodies, it just adds another layer of treatment for our patients and options that they just didn’t have before, either by single-agent activity with daratumumab, for instance, or adding on to get that synergy with other drugs.

Transcript Edited for Clarity

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