New Biological Agents Added to Treatment Algorithm for Multiple Myeloma

Novel therapy using several targeted agents has been incorporated into new guidelines from the National Comprehensive Cancer Network (NCCN) for treatment of multiple myeloma, presented at the NCCN 13th Annual Conference: Clinical Practice Guidelines and Quality Cancer Care.

The new agents that have been added to the NCCN's guidelines for treating cancer patients include:
· The proteasome inhibitor bortezomib. Proteasomes are enzymes that play a role in regulating cell function and growth.
· Thalidomide, which appears to inhibit the growth and survival of myeloma cells and to inhibit the growth of new blood vessels. Its precise mechanism of action is unknown. In the 1960s thalidomide was found to be responsible for birth defects and must not be taken by women who may become pregnant.
· Lenalidomide, an analog of thalidomide, which acts as an immune modulator, reducing cytokine proliferation that occurs in multiple myeloma.
· The anthracycline doxorubicin hydrochloride liposome injection, a cytotoxic agent.

"The effect on overall survival with these drugs is as yet unknown," said Kenneth C. Anderson, MD, the Kraft Family Professor of Medicine, Harvard Medical School, Boston, Massachusetts. "New drug combinations for front-line therapy are under evaluation using bortezomib, thalidomide, and lenalidomide."

In the updated guidelines for treatment of multiple myeloma, the drugs are indicated for use in advanced multiple myeloma patients along with cyclophosphomide and the combination of etoposide, dexamethasone, cytarabine, and cisplatin, Dr. Anderson said in a presentation on March 7th.

The guidelines suggest that other therapies for the treatment of relapse include thalidomide, lenalidomide, and bortezomib either as single agents or in combination with dexamethasone. Dr. Anderson also said that bortezomib can be used in combination, including with doxorubicin hydrochloride liposome injection.

"Other novel therapies to be conducted in clinical trials should also be considered," he added. The use of the drugs in the salvage setting is only for patients who have opted against transplantation to try to cure the disease. Thalidomide, bortezomib, and lenalidomide are mentioned in the guidelines for maintenance in transplantation.