Multiple myeloma highlights from ASCO 2016: monoclonal antibodies and oral proteasome inhibitors

Joseph Mikhael, MD from the Mayo Clinic, Scottsdale, AZ discusses his highlights for multiple myeloma (MM) from the American Society of Oncology (ASCO) 2016 Annual Meeting held in Chicago, IL. First, Prof. Mikhael discusses monoclonal antibodies and the CASTOR trial of daratumumab, bortezomib and dexamethasone vs bortezomib and dexamethasone presented by Dr Antonio Palumbo at ASCO (NCT02136134). At the moment, daratumumab is approved for monotherapy and later in the disease course. This study confirms the use of monoclonal antibodies earlier in the course of the disease and in combination according to Prof. Mikhael. He then discusses the POLLUX trial of daratumumab, lenalidomide and dexamethasone vs lenalidomide and dexamethasone (NCT02076009). Prof. Mikhael also mentions isatuximab, which is being developed and showing promise. Oral proteasome inhibitors are another area of note. For example, ixazomib is FDA approved in combination with lenalidomide in relapsed disease. It is also being used upfront and Prof. Mikhael discusses the combinations of ixazomib, lenalidomide and dexamethasone as well as ixazomib, cyclophosphamide and dexamethasone. These combinations show great response rates with managable toxicities according to Prof. Mikhael and may be of particular value for elderly patients. The validation of autologous stem cell transplant was another important topic at ASCO 2016. Finally, Prof. Mikhael discusses the meta-anlaysis by Dr Philip McCarthy on the use of lenalidomide as maintenance.

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