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COMy 2021 | Proteasome inhibitors in elderly patients with multiple myeloma

Maria-Victoria Mateos, MD, PhD, University of Salamanca, Salamanca, Spain gives an insight into proteasome-based approaches in treating elderly patients with multiple myeloma. Proteasome inhibitors such as bortezomib, ixazomib and carfilzomib can be used in combination with corticosteroids or monoclonal antibodies to improve outcomes in elderly patients. Bortezomib in combination with the standard of care melphalan and prednisone has been shown to improve patient survival and proteasome inhibitors also have the potential to be used in combination with immunomodulatory drugs. This interview took place during the 7th World Congress on Controversies in Multiple Myeloma (COMy), 2021.

Transcript (edited for clarity)

Sure, we know that the proteasome inhibitors are a key element in the treatment of patients with multiple myeloma. And in fact, we reviewed the treatment overview for patients with multiple myeloma and then specifically for the elderly population. The first new combination that was able to improve the survival of this population was based on the incorporation of the proteasome inhibitor bortezomib to the standard of care of melphalan and prednisone...

Sure, we know that the proteasome inhibitors are a key element in the treatment of patients with multiple myeloma. And in fact, we reviewed the treatment overview for patients with multiple myeloma and then specifically for the elderly population. The first new combination that was able to improve the survival of this population was based on the incorporation of the proteasome inhibitor bortezomib to the standard of care of melphalan and prednisone.

I could say that there is not basically any contraindication for the use of a proteasome inhibitors in elderly patients with newly diagnosed multiple myeloma. But definitely, I think that a proteasome inhibitors, bortezomib, ixazomib and carfilzomib, can represent the ideal compliments in order to be combined in order to potentiate and in order to generate optimal combinations for the management of elderly patients with multiple myeloma. For example, proteasome inhibitors in combination with adjusted corticosteroids are ideal combinations for frail patients or patients with renal impairment. Proteasome inhibitors can be also combined with the monoclonal antibodies, anti-CD38. We had the opportunity to see how there is at least an additive effect.

In the future, I think that we will combine proteasome inhibitors with immunomodulatory drugs, plus the monoclonal antibodies, anti-CD38. So, I would conclude saying that the proteasome inhibitors continue being crucial elements in the treatment of this population.

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Disclosures

Honoraria from lectures and participation in boards from: Janssen, BMS-Celgene, Abbvie, Amgen, Takeda, GSK, Sanofi, Oncopeptides, Pfizer, Regeneron, Adaptive, Roche, Bluebird-bio, Sea-Gen.

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