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Novel Treatment Regimens Improve Survival Rate in Multiple Myeloma

April 2017

Multiple myeloma, a malignancy of antibody-secreting plasma cells, is characterized by cancer cell infiltration of bone marrow and widespread skeletal destruction, resulting in hypercalcemia, renal insufficiency, anemia, bone pain, and fractures.1 The disease constitutes 1.8% of all cancers and slightly more than 15% of hematologic malignancies in the United States.1 The annual incidence is about 3.3 per 100,000 population, and 30,330 new cases and 12,650 deaths were attributed to the condition in 2016.2 New cases have risen by about 0.8% per year, with death rates falling at about same rate from 2004 through 2013.3

Advances in drug development and large randomized clinical trials, many with the participation of University of Minnesota, have significantly changed treatment options in the last decade. Findings from these trials have helped establish the current standard of care for patients with newly diagnosed multiple myeloma, a standard that includes induction therapy with multiagent chemotherapy regimens, consolidation therapy with autologous hematopoietic cell transplantation (autoHCT), and single-drug maintenance therapy.

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— Hematologist/oncologists Brian McClune, DO, and Mukta Arora, MD, MS, lead clinical trials investigating vaccines and drug therapies targeting multiple myeloma.

University of Minnesota Health hematologist/oncologists who serve as medical researchers at Masonic Cancer Center, University of Minnesota have been active in the efforts to improve treatments and patient outcomes. They were key members of a national multicenter study that demonstrated the efficacy of the multiple myeloma maintenance therapy lenalidomide in delaying relapse and prolonging survival (Lenalidomide in Treating Patients with Multiple Myeloma Undergoing Autologous Stem Cell Transplant).4 Data from this randomized, phase III study, which assigned patients to receive maintenance therapy with either lenalidomide or placebo after autoHCT, changed treatment practice. Now, with 10 years of followup, a recent reanalysis comparing maintenance therapy outcomes to those of patients treated with placebo continues to confirm substantially improved survival rates for patients given lenalidomide.5

The impact of additional interventions after autoHCT has been the focus of recent research, including clinical trials conducted by University of Minnesota Health physicians. In the randomized, NIH-supported multisite StaMINA trial, the established standard of care (induction, autoHCT consolidation, and lenalidomide maintenance therapy) was compared to 2 different forms of intensification delivered after HCT but before maintenance therapy. Progression-free survival and overall survival with addition of lenalidomide, bortezomib, dexamethasone consolidation or a second autoHCT was not found to be superior to a single autoHCT followed by lenalidomide maintenance in the upfront treatment of multiple myeloma.6 The trial demonstrates the need to study the incorporation of new drugs with different mechanisms of action. For now, the finding indicates it is not necessary to add other postautoHCT therapies that offer no benefit over the current standard of care using lenalidomide maintenance therapy.

The development and approval of new drugs such as lenalidomide, pomalidomide, carfilzomib, ixazomib, elotuzumab, and daratumumab have significantly improved response rates of both initial and relapsed therapies. With the advent of new combination regimens, patients who require transplants now have them with substantially less pre-transplant disease burden, owing to deeper remissions. Ongoing studies will test the incorporation of recently approved drugs and therapies in the accepted treatment paradigm of induction, autoHCT, and maintenance. Among the new approaches receiving research attention are advances in allogenic transplantation and immunotherapies using vaccines and natural killer cell administration. (See Specialty Updates for discussion of the clinical trials.)

References

  1. Palumbo A, Anderson K. Multiple myeloma. N Engl J Med. 2011;364:1046-1060.
  2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66:7-30.
  3. National Cancer Institute Surveillance, Epidemiology, and Results (SEER) Program. SEER Stat Fact Sheets: Myeloma.
  4. McCarthy PL, Owzar K, Hofmeister CC, Hurd DD, et al. Lenalidomide after Stem-Cell Transplantation for Multiple Myeloma. N Engl J Med. 2012;366(19):1770-1781.
  5. Unpublished results
  6. Stadtmauer EA, Pasquini MC, Blackwell B, Knust K, Bashey A, Devine SM, et al. Comparison of Autologous Hematopoietic Cell Transplant (autoHCT), Bortezomib, Lenalidomide (Len) and Dexamethasone (RVD) Consolidation with Len Maintenance (ACM), Tandem Autohct with Len Maintenance (TAM) and Autohct with Len Maintenance (AM) for Up-Front Treatment of Patients with Multiple Myeloma (MM). Blood. 2016;128(22):LBA-1

When to refer

University of Minnesota Health Cancer Care offers comprehensive diagnosis and treatment of patients who have hematologic malignancies, including lymphoma, leukemia and multiple myeloma. Treatment regimens for patients who have multiple myeloma are tailored to the individual patient and include chemotherapy, targeted therapy with drugs or protease inhibitors, high-dose chemotherapy with stem cell transplantation, biologic or immune therapies, radiation and surgery. Our specialists participate in multiple clinical trials assessing new and cutting-edge therapies for multiple myeloma.

Our teams work hard to keep physicians informed of patients’ care. Our staffs provide detailed reports, from diagnosis to treatment and follow-up.

To schedule a consultation or referral: 855-486-7226.

Collaborative Care

Patients have access to our network of specialists, and we work with the referring provider to extend communication and support to patients and their families. Many of our patients do not live in the Twin Cities metropolitan area. To minimize travel difficulties and lost time from school or work for our patients, our staff is committed to partnering with the patients’ referring providers and other local providers. Some patients can be initially discussed via telephone in collaboration with the referring provider. We seek to expedite the process so that trips to the Twin Cities are minimized. In many cases, care after discharge can also be provided locally.

Physician Outreach Program

To schedule a physician meeting or to visit our facility, contact Melinda Tuma, System Manager, Outreach Services. Phone: 612-867-3411; email: marvold1@fairview.org.

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