Future Directions in Myeloma

Table

With so many new myeloma drugs of various classes in the pipeline (Table), “myeloma is going to become a chronic ill­ness, with sustained complete responses in a significant fraction of patients,” according to Kenneth C. Anderson, MD, of Dana-Farber Cancer Institute and Harvard Medical School, Boston.

In his ASH 2011 presentation about treatment targets and niches, Dr Ander­son predicted that the future direction of multiple myeloma man­­age­­ment will include:

• Development of immune treat­ments (vaccine and adoptive im­muno­therapy); these may be very personalized
• Development of novel agents aimed at the myeloma cell in the bone marrow microenvironment; these will target cell growth, survival, and drug resistance
• Development of rationally based combination therapies, such as bortezomib plus histone deacetylase inhibitors
• Utilization of genomics for im­proved classification; microRNA profiles can already identify clinical subgroups with different survival outcomes
• Personalized treatment based on tumor genetics.

Sonja Zweegman, MD, PhD, of VU University Medical Center, Am­ster­dam, and Erasmus University, Rotterdam, the Netherlands, moderated the session on new agents in myeloma. She elaborated on the future of personalized treatment for myeloma: “We need many drugs to prolong the life of these patients, and what you will increasingly see happen is the use of biologically determined treatment.”

For example, she said, we heard here at ASH 2011, that with the MEK (mitogen-activated protein kinase kinase) inhibitor AZD6244 (selumetinib), only patients with activation of the signaling transduction pathway will respond.

“It will help to have a biological determination of the malignant plasma cells, and a predictive model to help select the most appropriate treatment for a particular patient. That will be the future,” said Dr Zweegman. 

Dr Anderson agreed. “With whole genome sequencing coming, and with so many novel agents—including many in phase 3 trials, as we saw discussed at this meeting—I know the future is bright in myeloma.”