Consider These 3 Things Before Determining Myeloma Treatment

Clinicians should consider patient-related factors, disease-related factors, and prior therapies before deciding on a treatment regimen for patients with relapsed/refractory myeloma.

Many patient factors must be considered before deciding on a treatment regimen for patients with relapsed/refractory multiple myeloma, according to Saad Z. Usmani, MD, FACP.

Usmani, chief of the Plasma Cell Disorders Program and director of clinical research in hematologic malignancies at the Levine Cancer Institute, said that he typically groups factors into 3 different buckets: patient-related factors, disease-related factors, and prior therapy.

These considerations are particularly important when choosing a 3-drug regimen, according to Usmani, who noted that there are multiple options to choose from nowadays.

“Many triplet options exist. You have to pay attention to the previous drugs that patients received and that kind of responses they had to them. [You want to know whether] patients had any drug-free intervals from specific drug classes, [so you can] pair them with the right 3-drug combination,” he explained in a recent interview with OncLive, a sister publication of Oncology Nursing News.

“There are situations where we start off with 2-drug combinations, especially in older, frail patients, and then consider the addition of a third drug. It’s more art than science [in that scenario,”

Patient-related factors that should be considered include age, comorbidities, socioeconomic support, and where the individual lives.

“These factors play a role in routes of administration and the kind of schedule you set up,” Usmani said.

Additionally, disease-related factors include:

  • how aggressive the relapse is
  • if the progression is a slow biochemical relapse
  • if the patient is clinically symptomatic
  • are they presenting with circulating plasma cells or extramedullary disease
  • is there any renal failure
  • does the patient have other high-risk genomic features on their karotypic analysis

Finally, clinicians must take the patient’s prior therapies into account, Usmani said, emphasizing stem cell transplant history, proteasome inhibitors (PIs), immunomodulary drugs, and monoclonal antibodies.

“Additionally, what adverse events did patients experience [on those treatments] and what was their tolerability to those approaches?” he said. “How long did their response last?”

Nurses and the treating time should also keep their eyes out for new or worsening comorbidities that the patient may have developed throughout the course of their disease and treatment.

“Over time, patients pick up other comorbidities. They may have not been diabetic or may not have had heart disease before, but at the time of relapse, they might.”

All things considered, 3-drug combinations tend to be better than 2-drug regimens.

“One of the things that we have learned over the past 8 years is that 3-drug combinations, or a multi-drug chemotherapy regimen, works better than 2-drug combinations,” Usmani said. “That is consistent with what we know about the disease biology of myeloma.”

A version of this article originally appeared on OncLive as, “Navigating Triplet Therapies in Relapsed/Refractory Multiple Myeloma.”