Developments in continuous therapy and maintenance treatment approaches for patients with newly diagnosed multiple myeloma
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Developments in continuous therapy and maintenance treatment approaches for patients with newly diagnosed multiple myeloma. / Dimopoulos, Meletios A; Jakubowiak, Andrzej J; McCarthy, Philip L; Orlowski, Robert Z; Attal, Michel; Bladé, Joan; Goldschmidt, Hartmut; Weisel, Katja C; Ramasamy, Karthik; Zweegman, Sonja; Spencer, Andrew; Huang, Jeffrey S Y; Lu, Jin; Sunami, Kazutaka; Iida, Shinsuke; Chng, Wee-Joo; Holstein, Sarah A; Rocci, Alberto; Skacel, Tomas; Labotka, Richard; Palumbo, Antonio; Anderson, Kenneth C.
In: BLOOD CANCER J, Vol. 10, No. 2, 13.02.2020, p. 17.Research output: SCORING: Contribution to journal › SCORING: Review article › Research
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TY - JOUR
T1 - Developments in continuous therapy and maintenance treatment approaches for patients with newly diagnosed multiple myeloma
AU - Dimopoulos, Meletios A
AU - Jakubowiak, Andrzej J
AU - McCarthy, Philip L
AU - Orlowski, Robert Z
AU - Attal, Michel
AU - Bladé, Joan
AU - Goldschmidt, Hartmut
AU - Weisel, Katja C
AU - Ramasamy, Karthik
AU - Zweegman, Sonja
AU - Spencer, Andrew
AU - Huang, Jeffrey S Y
AU - Lu, Jin
AU - Sunami, Kazutaka
AU - Iida, Shinsuke
AU - Chng, Wee-Joo
AU - Holstein, Sarah A
AU - Rocci, Alberto
AU - Skacel, Tomas
AU - Labotka, Richard
AU - Palumbo, Antonio
AU - Anderson, Kenneth C
PY - 2020/2/13
Y1 - 2020/2/13
N2 - The evolving paradigm of continuous therapy and maintenance treatment approaches in multiple myeloma (MM) offers prolonged disease control and improved outcomes compared to traditional fixed-duration approaches. Potential benefits of long-term strategies include sustained control of disease symptoms, as well as continued cytoreduction and clonal control, leading to unmeasurable residual disease and the possibility of transforming MM into a chronic or functionally curable condition. "Continuous therapy" commonly refers to administering a doublet or triplet regimen until disease progression, whereas maintenance approaches typically involve single-agent or doublet treatment following more intensive prior therapy with autologous stem cell transplant (ASCT) or doublet, triplet, or even quadruplet induction therapy. However, the requirements for agents and regimens within these contexts are similar: treatments must be tolerable for a prolonged period of time, should not be associated with cumulative or chronic toxicity, should not adversely affect patients' quality of life, should ideally be convenient with a minimal treatment burden for patients, and should not impact the feasibility or efficacy of subsequent treatment at relapse. Multiple agents have been and are being investigated as long-term options in the treatment of newly diagnosed MM (NDMM), including the immunomodulatory drugs lenalidomide and thalidomide, the proteasome inhibitors bortezomib, carfilzomib, and ixazomib, and the monoclonal antibodies daratumumab, elotuzumab, and isatuximab. Here we review the latest results with long-term therapy approaches in three different settings in NDMM: (1) maintenance treatment post ASCT; (2) continuous frontline therapy in nontransplant patients; (3) maintenance treatment post-frontline therapy in the nontransplant setting. We also discuss evidence from key phase 3 trials. Our review demonstrates how the paradigm of long-term treatment is increasingly well-established across NDMM treatment settings, potentially resulting in further improvements in patient outcomes, and highlights key clinical issues that will need to be addressed in order to provide optimal benefit.
AB - The evolving paradigm of continuous therapy and maintenance treatment approaches in multiple myeloma (MM) offers prolonged disease control and improved outcomes compared to traditional fixed-duration approaches. Potential benefits of long-term strategies include sustained control of disease symptoms, as well as continued cytoreduction and clonal control, leading to unmeasurable residual disease and the possibility of transforming MM into a chronic or functionally curable condition. "Continuous therapy" commonly refers to administering a doublet or triplet regimen until disease progression, whereas maintenance approaches typically involve single-agent or doublet treatment following more intensive prior therapy with autologous stem cell transplant (ASCT) or doublet, triplet, or even quadruplet induction therapy. However, the requirements for agents and regimens within these contexts are similar: treatments must be tolerable for a prolonged period of time, should not be associated with cumulative or chronic toxicity, should not adversely affect patients' quality of life, should ideally be convenient with a minimal treatment burden for patients, and should not impact the feasibility or efficacy of subsequent treatment at relapse. Multiple agents have been and are being investigated as long-term options in the treatment of newly diagnosed MM (NDMM), including the immunomodulatory drugs lenalidomide and thalidomide, the proteasome inhibitors bortezomib, carfilzomib, and ixazomib, and the monoclonal antibodies daratumumab, elotuzumab, and isatuximab. Here we review the latest results with long-term therapy approaches in three different settings in NDMM: (1) maintenance treatment post ASCT; (2) continuous frontline therapy in nontransplant patients; (3) maintenance treatment post-frontline therapy in the nontransplant setting. We also discuss evidence from key phase 3 trials. Our review demonstrates how the paradigm of long-term treatment is increasingly well-established across NDMM treatment settings, potentially resulting in further improvements in patient outcomes, and highlights key clinical issues that will need to be addressed in order to provide optimal benefit.
U2 - 10.1038/s41408-020-0273-x
DO - 10.1038/s41408-020-0273-x
M3 - SCORING: Review article
C2 - 32054831
VL - 10
SP - 17
JO - BLOOD CANCER J
JF - BLOOD CANCER J
SN - 2044-5385
IS - 2
ER -