The role of proteasome inhibitors in multiple myeloma

Mohamad Mohty, MD, PhD, from Saint-Antoine Hospital, Paris, France, and President of the European Society for Blood and Marrow Transplantation (EBMT), talks about the a symposium hosted at the 2016 Annual Meeting of EBMT, held in Valencia, Spain, focusing on the role of proteasome inhibitors in multiple myeloma (MM). In the last 15 years, we have lived with the 1st generation proteasome inhibitors for the treatment of MM, mainly bortezomib. However, in the recent years the research community has developed 2nd generation proteasome inhibitors, such as carfilzomib and ixazomib. This symposium focused on the mechanistic aspects of these inhibitors in the context of MM, the different drug combinations containing proteasome inhibitors in relapsed/refractory MM (doublet vs triplet combinations), and the most recent results from trials containing proteasome inhibitors. The ASPIRE trial showed the superiority of a triplet combination of carfilzomib, lenalidomide and dexamethasone, compared to lenalidomide and dexamethasone., in terms of progression-free survival (PFS) in relapsed/refractory MM. The results of other 2 clinical trials of ixazomib, lenalidomide and dexamethasone vs lenalidomide and dexamethasone, and carfilzomib and dexamethasone vs bortezomib and dexamethasone, revealed the importance of these novel drugs in high-risk cytogenetics patients, as it is likely that 2nd generations drugs will have higher efficacy in this hard-to-treat group of patients.

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