Novel Therapy May Be the First Line Treatment for Multiple Myeloma but Should Not Be the Last Word: Two Cases Illustrated
Lindsay McCullough
Department of Medicine, Division of Hematology and Oncology, University of Florida, Gainesville, FL 32610, USA.
Amy C. Davis
Department of Medicine, Division of Hematology and Oncology, University of Florida, Gainesville, FL 32610, USA.
Issam Hamadeh
Clinical Pharmacy, University of Florida, Gainesville, FL 32610, USA.
Ashley Richards
Clinical Pharmacy, University of Florida, Gainesville, FL 32610, USA.
Jan S. Moreb *
Department of Medicine, Division of Hematology and Oncology, University of Florida, Gainesville, FL 32610, USA.
*Author to whom correspondence should be addressed.
Abstract
Over the past 20 years, the treatment for multiple myeloma (MM) has evolved significantly. These pharmaceutical developments allow physicians to combine existing chemotherapy with newly approved novel and targeted medications to create various treatment regimens for MM. These novel drug combinations, immunomodulatory drugs (Thalidomide, lenalidomide and Pomalidomide) and proteasome inhibitors (Bortezomib and carfilzomib), are used upfront for induction therapy as well as for maintenance and treatment of subsequent relapses. However, the emergence of resistant myeloma clones to these drugs is usually inevitable. We describe 2 cases here that demonstrate beneficial response to old traditional chemotherapy combinations after patients become resistant to all novel drugs available. Therefore, our main message is that while novel drugs should be used in frontline combinations to treat MM patients, these novel drugs should not be the last word, and often going back to the old traditional chemotherapy may illicit response and possibly prolong survival.
Keywords: Multiple myeloma, novel drugs, salvage chemotherapy regimens, autologous stem cell transplantation, overall survival.