Multiple myeloma: the biology, the clinic, and the future

The landscape of myeloma therapy has been changing quickly over the last 15 years, and when looking at drugs currently in development in clinical trials we can expect further “revolutions” in the near future. Immunomodulatory substances are at present the favored “backbones” of myeloma therapy, with new drugs like the antimyeloma antibodies evaluated in combination with lenalidomide/dexamethasone or the new oral proteasome inhibitor ixazomib evaluated in combination with thalidomide/dexamethasone. Such “chemotherapy-free” triple combinations have the potential to evolve to standards of care in relapsed disease. Just recently, a favorable outcome was reported for patients receiving therapy with carfilzomib/lenalidomide/dexamethasone when compared with lenalidomide/dexamethasone alone (ASPIRE study) and also pomalidomide was evaluated in triple combinations (e.g., combined with bortezomib/dexamethasone), with high response rates reported in relapsed/refractory disease. …