Initial therapy in multiple myeloma: investigating the new treatment paradigm

The development of three novel chemotherapeutic agents — thalidomide, lenalidomide, and bortezomib — has resulted in a fundamental shift in the management of multiple myeloma. Despite this tremendous advancement, the selection of initial treatment must still be made with a degree of uncertainty as a...

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Bibliographic Details
Published in:Journal of oncology pharmacy practice 2009-09, Vol.15 (3), p.131-141
Main Authors: Kettle, Jacob K, Finkbiner, Karen L, Klenke, Susan E, Baker, Ronald D, Henry, Dave W, Williams, Casey B
Format: Article
Language:English
Subjects:
Antineoplastic Agents - therapeutic use
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Boronic Acids - therapeutic use
Bortezomib
Chemotherapy
Combined Modality Therapy
Comorbidity
Evidence-Based Medicine - trends
Hematopoietic Stem Cell Transplantation
Humans
Multiple myeloma
Multiple Myeloma - drug therapy
Multiple Myeloma - therapy
Pharmacology
Pyrazines - therapeutic use
Stem cells
Thalidomide - analogs & derivatives
Thalidomide - therapeutic use
Transplantation, Autologous
Transplants & implants
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Summary:The development of three novel chemotherapeutic agents — thalidomide, lenalidomide, and bortezomib — has resulted in a fundamental shift in the management of multiple myeloma. Despite this tremendous advancement, the selection of initial treatment must still be made with a degree of uncertainty as a true standard therapy has yet to be established. Although challenging, the relative abundance of therapeutic options, when taken into consideration with unique patient characteristics, creates the potential for individualization of care. For patients eligible for autologous stem cell transplantation, various combinations of novel agents with dexamethasone or traditional chemotherapy have supplanted the previous standard regimen consisting of vincristine, doxorubicin, and dexamethasone. In elderly patients or others that are deemed ineligible for the transplant procedure, the addition of a novel agent to melphalan-prednisone has demonstrated significant improvements in response rates. Due to the immaturity of the available data, it is perhaps best to regard the era of novel agents with a degree of rational enthusiasm, as the ultimate impact on patient care remains undetermined. Although further research is clearly implicated, recent advancements have resulted in significant progress toward obtaining optimum outcomes in a historically challenging disease.
ISSN:1078-1552
1477-092X
DOI:10.1177/1078155208101096