The Future of Multiple Myeloma Treatment

By Saad Z. Usmani, MD and Peter Voorhees, MD

Every time we’re in the clinic, we come face-to-face with patients who have multiple myeloma and are looking for the best chance to extend their lives. Some of these patients are newly diagnosed, others have relapsed and are running out of options. All of them deserve the latest, most promising therapies.

That’s why, at Levine Cancer Institute (LCI), we’re using clinical trials to give these patients access to a new generation of multiple myeloma treatments – including monoclonal antibodies and CAR T-cell therapies – that could help more patients lead longer, healthier lives.

Monoclonal Antibodies for Multiple Myeloma

Monoclonal antibodies have transformed treatment for breast cancer and B-cell non-Hodgkin lymphoma – and are delivering a powerful new option against multiple myeloma. These antibodies can directly kill cancer cells and coax the immune system to attack them, and are far easier to tolerate than traditional therapies.

Our physicians led the first clinical trials showing that a monoclonal antibody called daratumumab, which targets the CD38 protein, improves progression-free survival in patients with relapsed/refractory multiple myeloma. Since then, we’ve methodically shown that the drug can be effective earlier in the course of disease, and can be combined with drugs like lenalidomide, bortezomib and dexamethasone to increase response rate and extend survival.

Can Minimal Residual Disease Testing Improve Treatment?

One of these trials, which completed enrollment in April 2018, adds daratumumab to lenalidomide, bortezomib and dexamethasone. The other trial merges daratumumab with carfilzomib, lenalidomide and dexamethasone – and is one of the first multiple myeloma trials that incorporates minimal residual disease (MRD) testing to guide treatment.

MRD testing uses molecular tests that can pinpoint a single myeloma cell in the midst of one million other cells. This enables us to precisely monitor a patient’s disease, and we’re hopeful that continuing treatment until myeloma has reached minimal levels can reduce the odds of relapse and significantly extend survival.

The Region’s Most Comprehensive Clinical Trials Program

The daratumumab trials are only one part of our push to improve multiple myeloma treatment. Our other clinical trials include:

• Trials of bispecific monoclonal antibodies. These trials include a first-in-human trial of a bispecific monoclonal antibody that targets the BCMA protein and directs immune cells to attack myeloma cells.
• CAR T-cell immunotherapies for multiple myeloma that will open late 2018.
• The first-ever trial that combines the monoclonal antibody elotuzumab with carfilzomib, lenalidomide and dexamethasone for multiple myeloma in first relapse.
• A Phase III trial that studies if subcutaneous administration of daratumumab is non-inferior to intravenous administration. A subcutaneous approach could free patients from the inconvenience of intravenous infusions that last for hours.
• Phase I and II trials evaluating antibody drug conjugates targeting BCMA and CD48A.

Multiple Myeloma Experts

Levine Cancer Institute’s multiple myeloma specialists were trained by the world’s top experts and hold leadership positions in the Southwest Oncology Group and the Alliance for Clinical Trials in Oncology. We are one of just 22 Multiple Myeloma Research Consortium centers in the US and are active members of the International Myeloma Working Group that develops the latest guidelines for diagnosis and management of multiple myeloma.

As one of the most active multiple myeloma programs in the country, we have the expertise – and the experience – to understand your patient’s disease, and match them with therapies and clinical trials that deliver the best opportunity for a good outcome.

For questions, or to make a referral, call 980-442-3300.