Back to Journals » Biologics: Targets and Therapy » Volume 3

Front line treatment of elderly multiple myeloma in the era of novel agents

Authors Venon M, Roccaro AM, Gay J, Moreau A, Dulery R, Facon T, Ghobrial IM, Leleu X

Published 30 October 2008 Volume 2009:3 Pages 99—109

DOI https://doi.org/10.2147/BTT.S4275

Review by Single-blind

Peer reviewer comments 4

Marie-Dominique Venon2, Aldo M Roccaro1,3, Julie Gay2, Anne-Sophie Moreau1,2, Remy Dulery2, Thierry Facon2, Irene M Ghobrial1, Xavier Leleu1,2

1Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA; 2Service des Maladies du Sang, Hopital Huriez, CHRU, Lille, France; 3Units of Blood Diseases and Cell Therapies, University of Bresica, Medical School, Bresica, Italy

Abstract: Melphalan combined with prednisone (MP) has long been the historical treatment of reference for a large proportion of elderly myeloma (MM) patients ineligible for autologous stem cell transplantation, and is still the backbone of new regimens that include the new era of novel agents. Melphalan–prednisone–thalidomide (MPT) and melphalan–prednisone–bortezomib (Velcade®, MPV), proved superior to MP, currently appear to be the treatments of choice for this population. In the near future melphalan–prednisone–lenalidomide (Revlimid®, MPR) will also provide a third therapeutic option (MPT, MPV, and MPR), in elderly multiple myeloma, eventually. These options could lead to more personalized treatment approaches, based on patient comorbidities, as the three novel agents have somewhat different toxicity profiles. Dexamethasone-based regimen is another option and questions regarding the relative efficacy of melphalan-based versus low-dose dexamethasone-based regimens will require randomized phase III trials. More intensive approaches with new drug combinations or with the incorporation of polyethylene glycolated (PEGylated) liposomal doxorubicin will also require additional studies. Additionally, the important issue of maintenance treatment needs to be further investigated. These new and emerging therapies offer multiple effective treatment options for MM patients and greatly enhanced treatment strategies for clinicians.

Keywords: multiple myeloma, elderly, bortezomib, thalidomide, revlimid, IMiDs, supportive care

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]