Optimising Treatment in Relapsed, Refractory Multiple Myeloma

Novel agents in multiple myeloma (MM), notably the proteasome inhibitors ixazomib and carfilzomib, the therapeutic monoclonal antibodies daratumumab and elotuzumab, and the new immunomodulatory drug pomalidomide, have helped to transform treatment paradigms for relapsed/refractory disease. Research into triplets containing novel agents has supported their superior efficacy over standard doublet combinations for relapsed/refractory MM. Toxicity profile is generally favourable and there is also emerging evidence of quality-of-life benefit. Importantly, novel agents can help address some of the key treatment challenges in myeloma, offering the opportunity for clinicians to more closely align therapeutic choices with individual patient needs. This is particularly important for specific subpopulations where obvious unmet needs still exist, such as in elderly, unfit or frail patients, those with high-risk cytogenetic abnormalities and patients burdened with toxicity-related complications and comorbidities. In this article, we review the available data and evidence for novel agents in the relapsed/refractory setting, and discuss their key role in tailored treatment strategies aimed at optimising current clinical practice.