Published on August 19, 2020
New Multiple Myeloma Therapies on the Horizon
Multiple myeloma (MM) is a cancer of the plasma cells, a type of white blood cell in your bone marrow. This year, approximately 32,270 adults in the United States will be diagnosed with multiple myeloma, according to the American Society of Clinical Oncology.1,2 It is the second most common blood cancer in the United States, after non-Hodgkin lymphoma (NHL).
There is a lot happening in multiple myeloma research right now, and Patient Power’s Cindy Chimielewski along with patient advocate (now in remission!) Yolanda Brunson led a discussion with prominent researchers to ask about the latest multiple myeloma treatment options: belantamab mafodotin, daratumumab (Darzalex) and selinexor (Xpovio).
Belantamab for Multiple Myeloma
“This drug falls into a category called an ADC or an antibody-drug conjugate,” Dr. Cesar Rodriguez of Wake Forest University explained during the myeloma panel discussion.
“This drug attaches to other immunotherapy drugs and amps up the efficacy,” he said. “When you get it intravenously, it does a scavenger hunt. It tries to find any cell that has a surface marker called BCMA.”
The B-cell maturation antigen, or BCMA marker, is a protein mainly found in plasma and myeloma cells. Using BCMA as a guide, belantamab eventually finds the cancer cell and destroys it, harnessing the power of the patient’s own T cells, which are an important part of the immune system.
Side Effects of Belantamab
Patients taking belantamab may experience side effects of treatment, including thrombocytopenia and keratopathy.
Thrombocytopenia is a condition that causes patients to have low platelets, which are needed to form blood clots to offset bleeding. Patients may need medications, blood, or platelet transfusions to get their levels back to normal or near normal.
Keratopathy affects the eyes and can cause dryness and blurred vision, or sensitivity to bright lights. Eye drops and other treatments for keratopathy are available.
“In the studies, what we've done to manage this side effect, if it appears, is typically hold the drug or lower the dose of the drug,” said myeloma researcher Dr. Natalie Callander of the University of Wisconsin, who recommends patients have periodic appointments with eye specialists.
To learn more about belantamab, watch Belantamab mafodotin (Blenrep) FDA approved for Multiple Myeloma.
Daratumumab (Darzalex) for Myeloma Treatment
Another drug, daratumumab (Darzalex), binds to the CD38 marker, which multiple myeloma cells overexpress. When combined with hyaluronic acid and injected into the skin, daratumumab gets into the body more effectively than through an IV infusion.
Some patients taking daratumamab may experience bruising or skin irritation.
For those undergoing IV infusion, there is a greater risk of side effects. However, certain medications such as Benedryl or steroids, given ahead of time can offset some of those effects, making the experience more comfortable for the patient.
How is Selinexor Used to Treat Myeloma?
The panel also discussed selinexor (Xpovio) for patients with relapsed/refractory multiple myeloma.
“There was just the BOSTON trial that came out, combining selinexor with Velcade [a type of chemotherapy targeted therapy] which looked like they had very good response rates, and I believe that they will be going for that indication with Velcade very shortly,” Dr. Callendar said.
High doses of selinexor led to less tolerable side effects, but lower doses are well-tolerated and many patients are able to stay on selinexor alone, or in combination with other medications, for longer periods of time.
Patient Power’s Andrew Schorr discussed ongoing clinical trials with Dr. Joshua Richter and Dr. Luciano Costa in Bispecific Antibodies, Selinexor and Myeloma Clinical Trials.
“Selinexor is a good drug for people who have had a lot of other therapies. It's really all about the dose,” Dr. Richter said.
Is This Myeloma Drug Effective, Safe?
Patients vary in how well they tolerate therapies and the side effects of different treatments.
“One of the main objectives of the clinical trials is [to answer the question] ‘Is the drug effective?’ but at the same time, the other very important question that we're trying to answer is, ‘Is this drug safe?’” Dr. Rodriguez said.
At the end of the study, the researchers add up all of the side effects to see what percentage of patients experienced certain symptoms and then assign a grading system, 1 through 4 to measure the severity.
“In the end, you are an individual you are not a statistic and the odds of you getting a side effect are 50/50 — you either have it or you don't,” he added.
The good news is that there are a lot more options for patients with multiple myeloma now than there were just a few years ago. If you have questions about any of the drugs mentioned above, talk to your hematology/oncology team. That’s how you’ll get the care that’s right for you.
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~Lauren Evoy Davis
1Multiple Myeloma Statistics. Cancer.Net
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