What do scholars refer to as effective tx for myeloma?

for recurrent and non-responsive multiple myeloma

IRd or KRd therapy used in patients with first recurrence. It is important to select an appropriate drug according to the disease condition

IRd therapy, treatment for high-risk patients can continue

With the release of various new drugs over the past decade, treatment results for multiple myeloma have been gradually improving.

 

This is because as options vary, opportunities for "customized treatment" to select drugs depending on patients expand.

 

Professor Eom Hyun-seok (left) and Professor Kwee Yong (right) who are conducting video talks

Medical staff's attention is focused on which patients should be used to maximize the effectiveness.

 

In particular, third-drug therapy centered on second-generation proteasome inhibitors (PI) is a trend in patients with first recurrence.

 

As KRd therapy (Carfilzomib+ Revlimid +Dexamethasone) centered on Kyprolis and IRd therapy (Ixazomib+Revlimid+Dexamethason) centered on Ninlaro compete, the process of identifying appropriate drug choices considering drug characteristics and patient conditions continues.

 

Takeda held an academic conference between British and Korean medical staff on the treatment of recurrent and refractory multiple myeloma according to patient characteristics such as disease risk and cytogenetic high-risk groups.

 

Eom Hyun-seok, director of the National Cancer Center Hospital (Professor of Hematology and Oncology), an authority in the field of blood cancer, and Kwee Yong, a professor at University College London, participated in the meeting.

 

Professor Eom Hyun-seok: What are the guidelines for selecting IRd and KRd as secondary therapies for patients with recurrent and refractory multiple myeloma?

 

Professor Kwee Yong: Proteasome inhibitor and Lenalidomide combination therapy are very good methods in secondary treatment.

 

Most patients will reach a therapeutic response with this combination therapy.

 

The issue is which one to choose between IRd and KRd.

 

The risk of the disease is first identified, and then whether it recurred early or aggressive.

 

If the disease is aggressive and recurs early, has extra-bone marrow lesions, has high M protein levels, and the disease progresses quickly, KRd should be selected.

 

However, patients should be young and able to visit the hospital every week.

 

It is a very intensive treatment.

 

On the contrary, if the condition is not aggressive and recurrence is not carried out early, so the progressive survival period (PFS) is at least 18 to 24 months, IRd will be selected.

 

It is a fairly comfortable treatment for patients in many aspects.

 

The side effects of KRd's Kyprolis require more careful attention.

 

In particular, they have a history of heart disease or kidney damage.

 

Professor Eom Hyun-seok: If so, can high-risk groups be classified into KRd according to the patient's risk and IRd if it is a general risk?

 

Professor Kwee Yong: There is no clear standard.

 

This is because IRd responses are very good even in patients who are genetically at high risk.

 

If we have to make a distinction, the aggression of the disease, the pace of disease progression, and the burden of the disease will be more consistent.

 

Professor Eom Hyun-seok: How do you see the use of IRd in multiple myeloma with advanced extra-bone marrow lesions?

 

Professor Kwee Yong: Treatment is very difficult when extra-bone marrow lesions have progressed.

 

In terms of experience, even if the reaction appeared, it did not last very long.

 

I will choose a combination treatment based on proteasome inhibitors and IMiD, an immunomodulatory anticancer drug.

 

Even when extra-bone marrow lesions progressed, there were cases in which the response was very good with IRd treatment.

 

Professor Eom Hyun-seok: In the case of early recurrence, there may be characteristics of high-risk groups, and if the response appears slowly while presenting the case, the duration of the reaction will be extended.

 

Is there anything additional to say about the reaction time and timing of recurrence?

 

Professor Kwee Yong: First of all, I would like to tell you that there is not only one type of high risk of disease.

 

Some high-risk factors speed up disease progression and respond quickly.

 

Some patients with chromosome defects 17 are thought to have a single opposing genetic effect.

 

The important thing is that treatment should be maintained.

 

If treatment is stopped, it does not work.

 

In some high-risk patients, such as chromosome 1 acquisition or chromosome 17 defect, it takes a long time to respond, but if treatment continues, it will be maintained well.

 

Professor Eom Hyun-seok: In the case of the high-risk patients, it is important to continue treatment.

 

Professor Kwee Yong: So the advantage of IRd is that it can continue to treat proteasomes inhibitors.

 

It is difficult in VRd or KRd.

 

Professor Eom Hyun-seok: Another part is about clinical practice.

 

There are a variety of important clinical trials related to secondary treatment, which are slightly different from real world data, so you should be careful in interpreting these data.

 

Professor Kwee Yong: There are several clinical trials and the number of previous treatments varies from one to three.

 

However, most of the large-scale clinical trials were conducted before Lenalidomide was widely used.

 

These clinical trials are not very useful these days because the proportion of patients exposed to lenalidomide was small and they were not refractory to lenalidomide.

 

This is especially true if the patient has already received lenalidomide treatment.

 

Clinical trials have shown good results for Renalidomide three-drug therapy such as Daratumab-Lenalidomide-Dexamethason, KRd, and IRd.

 

However, when looking at the meta-analysis data, the margin benefit is similar.

 

In addition, these clinical trials exclude many patients with poor performance data, patients with renal dysfunction, and patients with low platelet levels that we meet at the clinic every day.

 

Professor Eom Hyun-seok: In Real World, it is very important whether the drug resistance or treatment continues.

 

For patients, discontinuation of treatment is not the best, but I think excellent drug resistance is one of the biggest advantages of IRd.