Relapsed-Refractory multiple myeloma

FDA-Approved Options for Treatment in Patients With Relapsed or Refractory Multiple Myeloma

Relapsed or refractory Multiple Myeloma often known as RRMM, basically is a kind of disease which becomes non-responsive or progressive on the therapy or within 60 days of the last treatment in those patients who had reached at the minimal response (MR) or better on the prior therapy.

Single Regimens:

Pomalidomide: Pomalidomide was approved by the US FDA in order to treat RRMM (relapsed or refractory multiple myeloma). It got approved for use in patients who have received at least 2 prior therapies including bortezomib and lenalidomide and have demonstrated disease progression on or within 2 months of the completion of the last treatment or therapy. 

Bortezomib: Bortezomib is prescribed for the treatment of RRMM. For multiple myeloma patients who were given a finite course of the bortezomib, their disease may have remained sensitive to the bortezomib based therapy at relapse. 

Doublet Regimen:

Bortezomib/dexamethasone: Bortezomib/dexamethasone specifically is a combination medicine against the Multiple Myeloma. When bortezomib is considered by the trade name Velcade, the combination is known as Vel/Dex (or Vel-Dex or Veldex). In this combination, bortezomib is a proteasome inhibitor and dexamethasone is a corticosteroid.

Lenalidomide/low-dose dexamethasone (Rd): The combination of lenalidomide and low dose dexamethasone has been approved as a treatment option for patients with RRMM who were given ≥1 prior therapies. The approval took place on the findings of the MM-021 registration trial, a large phase 2 study, evaluated the efficacy as well as safety of the lenalidomide and low dose dexamethasone (Rd) in patients with RRMM. 

Triplet Regimens:

Lenalidomide/bortezomib/dexamethasone (RVD): The triplet combination of lenalidomide, bortezomib and dexamethasone (RVD) has demonstrated excellent efficacy in patients with relapsed or refractory multiple myeloma (RRMM). 

Cyclophosphamide, lenalidomide, dexamethasone (CRD): Addition of the cyclophosphamide helps delay the progression in patients who present a biochemical relapse during treatment with the lenalidomide, dexamethasone. The SR and the duration of the progression free survival obtained with minimal toxicities and low costs induced us to setting up the randomized clinical trial.

Bortezomib/cyclophosphamide/dexamethasone (VCd): Bortezomib, cyclophosphamide and dexamethasone (VCd) basically is an IMiD sparing regimen that has shown high response rates and a tolerable safety profile in newly diagnosed RRMM. 

Vincristine, Adriamycin, and dexamethasone (VAD): The triplet VAD (vincristine, adriamycin, and dexamethasone chemotherapy has been used in order to reduce the burden of tumor in multiple myeloma as a preparation for the transplantation. Vincristine, doxorubicin (Adriamycin), and dexamethasone is given as a 4-day continuous intravenous infusion of the vincristine and doxorubicin, together with 4 daily oral doses of the dexamethasone.

Panobinostat, bortezomib, and dexamethasone: In August 2015, the EC authorized panobinostat for use together with the bortezomib and dexamethasone in order to treat relapsed or relapsed and refractory multiple myeloma (MM) in patients who have taken ≥2 prior regimens including bortezomib and an immunomodulatory drug. 

Elotuzumab, bortezomib, and dexamethasone: Elotuzumab, bortezomib, and dexamethasone (EBd) was well tolerated in patients with RRMM, with an ORR of 48% and median time to progression of 9.5 months, which indicates improved activity. Thus the addition of the elotuzumab to the bortezomib and dexamethasone would boost the progression-free survival (PFS) relative to bortezomib, and dexamethasone alone in patients with Refractory or Relapsed MM.

Elotuzumab (or daratumumab), lenalidomide, and dexamethasone: Elotuzumab together with lenalidomide and dexamethasone, even though it has been approved, but has not been used as much, primarily because the patients often serve to be refractory to the Revlimid (lenalidomide) by the time they get to their second-line treatment. 

By adding it together with pomalidomide, this triplet can certainly be prescribed even in patients who are refractory to lenalidomide, and increase upon the spectrum of the patients in whom this combination can be considered.

Carfilzomib, liposomal doxorubicin, and dexamethasone (KDD): The triplet carfilzomib, liposomal doxorubicin and dexamethasone is an effective salvage regimen for patients with relapsed refractory multiple myeloma (RRMM). Carfilzomib, specifically is a second generation proteasome inhibitor, has clinical efficacy even among bortezomib refractory patients. Carfilzomib, doxorubicin, and dexamethasone was quite well tolerated and appears efficacious in the RRMM (relapsed or refractory multiple myeloma).

Other Regimens: Apart from doublet and triplet regimen, there are certain other regimens, which are listed as follows:

  • Dexamethasone/cyclophosphamide/etoposide and cisplatin (DCEP). 
  • Dexamethasone/thalidomide/cisplatin/doxorubicin/cyclophosphamide and etoposide (DT-PACE). 
  • Dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophosphamide, etoposide, and bortezomib (VTD-PACE). 

Important:- This piece of information originally published here

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