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Individualizing Treatment Within Clinical Pathways for Multiple Myeloma

Authored by

JCP Editors


J Clin Pathways. 2018;4(suppl 2):S18.

Standardizing treatment options for relapsed/refractory multiple myeloma poses a challenge to clinical pathway decision-makers, due to the need to individualize treatment decisions for the patient’s specific circumstances. Other challenges to treatment decision-making for relapsed/refractory multiple myeloma include the disease’s heterogeneity and the recent proliferation of novel therapeutics and combinations.

Physicians must not only track the ever evolving treatment landscape for multiple myeloma but also rapidly incorporate these updates into clinical pathways for the disease. Dr Abbas discussed the current state of treatment and clinical pathways for multiple myeloma, as well as what is next on the horizon.

How do you expect standard-of-care treatment strategies and clinical pathways for multiple myeloma to change in the coming year, especially in regard to new therapies?

Standards of care for multiple myeloma practices should be changing rapidly and dramatically in the next few years. We have seen many new agents approved for multiple myeloma in the last 5 to 10 years, and trials are underway to determine the optimal combination of these agents. Trends in treatments are moving towards using our newest and most effective drugs in combination therapy in earlier lines of treatment. For this to be validated, however, we have to look at minimal residual disease to determine if the improved depth of response we’re achieving correlates to longer term survival.

Which settings in multiple myeloma are most in need of further research? Are there any noteworthy clinical trials taking place to address this need?

The most exciting area of research for multiple myeloma right now is the use of chimeric antigen receptor T-cell (CAR-T) therapy for the disease. Early studies showed remarkable efficacy of close to 100%, but with longer follow up, it seems that a significant proportion of patients are relapsing around the 1-year mark. This technology is currently approved for lymphoma and leukemia and can be a curative modality for those diseases, so perfecting CAR-T therapy for multiple myeloma in the upcoming years will be a fascinating new potential curative option.

How does Banner MD Anderson approach its clinical pathways for multiple myeloma, and what factors are considered most?

When determining our clinical pathways for multiple myeloma, we look at both current practice guidelines as well as advances in published and presented regimens not yet approved.

Most important, however, is individual patient characteristics. Preexisting comorbidities that may make them ineligible for certain treatments, distance to our center, level of family support, personal preference for intravenous vs oral medications, etc, all play a tremendous role in individualizing a treatment plan for a patient. 

Dr Abbas gave an Innovation Theater presentation entitled “The IMiD Foundation in Myeloma Therapy Revlimid® and Pomalyst® Phase 3 Clinical Data,” sponsored by Celgene.

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