|LETTER TO EDITOR
|Year : 2019 | Volume
| Issue : 2 | Page : 271-272
Changing landscape of induction therapy in newly diagnosed multiple myeloma
Nidhi Tandon1, Santhosh Kumar Devadas2, Mansi Khanderia1
1 Department of Medical Oncology, Mazumdar Shaw Medical Center, Bengaluru, Karnataka, India
2 Department of Medical Oncology, Ramaiah Medical College, Bengaluru, Karnataka, India
|Date of Web Publication||20-Dec-2019|
Department of Medical Oncology, Mazumdar Shaw Medical Center, Narayana Hrudayalaya, Bommasandra Industrial Area, Bengaluru - 560 099, Karnataka
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Tandon N, Devadas SK, Khanderia M. Changing landscape of induction therapy in newly diagnosed multiple myeloma. Cancer Res Stat Treat 2019;2:271-2
|How to cite this URL:|
Tandon N, Devadas SK, Khanderia M. Changing landscape of induction therapy in newly diagnosed multiple myeloma. Cancer Res Stat Treat [serial online] 2019 [cited 2020 Feb 28];2:271-2. Available from: http://www.crstonline.com/text.asp?2019/2/2/271/273701
Bagal and Bonda have put forth a very comprehensive article about the development of the regimens used in induction therapy in newly diagnosed multiple myeloma (NDMM), which have resulted in deeper and more durable responses that translate into improved overall survival.
Despite the advances in diagnosis, prognosis, and staging of MM and the incorporation of various novel therapies, the intrinsic or acquired resistance to treatment leads to eventual relapse and fatal outcomes in vast majority of patients. Hence, MM still remains an incurable disease with an overall survival of 52.2% at 5 years according to surveillance, epidemiology, and end results analysis. This article, therefore, becomes imperative as it discusses the strategies aimed at improvement of the existing induction regimens which will not only resolve the associated end-organ damage as early as possible but will also result in deeper and more durable responses, including minimal residual disease (MRD) negativity.
The review gives us extensive detail about the role of newer proteasome inhibitors (PI, carfilzomib) and immunomodulators (IMiD, pomalidomide), addition of another cytotoxic drug (alkylator/anthracyclines) or monoclonal antibodies (daratumumab), and personalized induction regimens based on genomic alteration. It is addressed that the way forward might be a monoclonal antibody-based quadruplet regimen incorporating PI, IMiD, and steroids which will be a major milestone in the treatment paradigm of NDMM. The authors also emphasize the significance of adding a cytotoxic drug or sequential use of available agents in resource-limited settings.
The importance of achievement of the best depth of response including MRD negativity with the use of induction therapy has been stressed upon in the article. However, it will be worthwhile to add that a rapid or late achievement of very good partial response or better with first-line treatment does not affect long-term survival outcomes. Furthermore, the authors might include the role of multidrug regimen such as VDTPACE incorporating bortezomib in patients presenting with very aggressive disease, including plasma cell leukemia features or rapidly progressive disease with or without extramedullary features. In addition, the contribution of personalized treatment based on disease biology including cytogenetics such as the impact of bortezomib in patients with t(4;14) and perhaps del(17p) and the use of carfilzomib in high-risk myeloma could be highlighted.
In conclusion, monoclonal antibody-based regimens are making their way to the frontline setting for both transplant-eligible and transplant-ineligible patients with NDMM. Emerging treatment strategies will offer individualized treatment options using risk stratification to guide choice of induction therapy and may ultimately lead to the possibility of a cure for myeloma patients.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Bagal B, Bonda A. Induction therapy in newly diagnosed multiple myeloma: Current research scenario and questions for the future. Cancer Res Stat Treat 2019;2:76-82. [Full text]
Tandon N, Sidana S, Rajkumar SV, Gertz MA, Buadi FK, Lacy MQ, et al.
Outcomes with early response to first-line treatment in patients with newly diagnosed multiple myeloma. Blood Adv 2019;3:744-50.
Kapoor P, Ramakrishnan V, Rajkumar SV. Bortezomib combination therapy in multiple myeloma. Semin Hematol 2012;49:228-42.
Paul B, Lipe B, Ocio E, Usmaani S
. Induction therapy for newly diagnosed multiple myeloma. Am Soc Clin Oncol Educ Book 2019;39:e176-86.