The Impact of Evolving Treatment Options in Multiple Myeloma, Part 1

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Joseph Mikhael, MD, reviews the history of multiple myeloma treatment and comments on the evolution of care.

Bruce A. Feinberg, DO: Hello, and welcome to this AJMC® webcast program titled, “The Impact of Evolving Treatment Options in Multiple Myeloma.” I’m Dr Bruce Feinberg, vice president and chief medical officer at Cardinal Health Specialty Solutions. Joining me today for this virtual discussion are my colleagues, Dr Joseph Mikhael, professor at the Translational Genomics Research Institute, an affiliate of City of Hope; Dr Ryan Haumschild, director of pharmacy services at Emory Healthcare in the Winship Cancer Institute; and Thomas Ollis, director of pharmacy at Regional Cancer Care Associates.

Today our panel of experts will be discussing the complexities of multiple myeloma, review best practices, the dispensing of treatments, and explore the clinical and payer considerations of emerging treatments.

Thank you for joining us. Multiple myeloma is incredibly complex, and for those of you who are less familiar, you may think of this as a less common, not top 10 cancer that’s managed in practice. Yet, if you were in community practice and a generalist, multiple myeloma is certainly one of your top 10 diseases. These patients have a very long life expectancy with disease. They undergo extensive amounts of treatment over what can be a decade or more. The treatments have evolved with unbelievable complexity over the prior decade, and the number of new agents is staggering. For so many reasons, this is a disease of the moment, so we want to take some time and help you understand what’s happening in this disease.

Joe, we’re going to start with you, because as our clinical expert who manages disease day in, day out, I thought you could discuss the last 2 decades and how we’ve gone from more or less single-agent treatment to what now could be combinations of up to 4 agents. We’ve already had the role of transplantation for part of this disease for decades, but now we’ve got new therapies like CAR T [chimeric antigen receptor T-cell therapy]. Treatment is rapidly evolving and very complex. Can you level set us and discuss where this journey has taken us?

Joseph Mikhael, MD: I’ll cram the last 20 years of history into a few sentences, whereby as you’ve mentioned, we’ve really gone through a revolution in myeloma. It’s been the product of introducing a whole series of new mechanisms of action and treatments. We’ve learned that when we use them in combination and earlier in the disease course, we can actually affect a patient’s long-term survival. The right use of these novel agents, and still using autologous stem cell transplant, we’ve found that we’ve gone from using a single drug to doublets, to triplets, and maybe before long to quadruplets of drugs. Knowing that myeloma is complicated and often has multiple clones within it, we’re coming at it from multiple angles. Similar to how we overcame HIV with multiple different mechanisms of action and drugs together, as opposed to a single one, this is the approach we’re taking now with multiple myeloma. This is so patients can have a deeper, more durable response, and more quality and quantity of life.

Transcript Edited for Clarity