Focus on Multiple Myeloma: Expert Insights and Strategies for Refining Patient Care This activity is supported by educational grants from Amgen; Celgene.

Name: Focus on Multiple Myeloma: Expert Insights and Strategies for Refining Patient Care This activity is supported by educational grants from Amgen; Celgene.
Uploaded: 2017-12-26T21:47:35+00:00
Duration: PTM46S43
Channel: Jerome Carson
Description: Focus on Multiple Myeloma: Expert Insights and Strategies for Refining Patient Care This activity is supported by educational grants from Amgen; Celgene.

Focus on Multiple Myeloma: Expert Insights and Strategies for Refining Patient Care
This activity is supported by educational grants from Amgen; Celgene Corporation; Janssen Biotech, Inc. administered by Janssen Scientific Affairs, LLC; and Takeda Oncology.

About These Slides Users are encouraged to use these slides in their own noncommercial presentations, but we ask that content and attribution not be changed. Users are asked to honor this intent These slides may not be published or posted online without permission from Clinical Care Options ( Disclaimer The materials published on the Clinical Care Options Web site reflect the views of the authors of the CCO material, not those of Clinical Care Options, LLC, the CME providers, or the companies providing educational grants. The materials may discuss uses and dosages for therapeutic products that have not been approved by the United States Food and Drug Administration. A qualified healthcare professional should be consulted before using any therapeutic product discussed. Readers should verify all information and data before treating patients or using any therapies described in these materials.

Faculty Jacob P. Laubach, MD, MPP Associate Professor of Medicine Harvard Medical School Clinical Director Jerome Lipper Multiple Myeloma Center Dana-Farber Cancer Institute Boston, Massachusetts Jacob P. Laubach, MD, MPP, has disclosed that he has received consulting fees from Novartis and Takeda and funds for research support from Celgene, Novartis, Onyx, and Takeda. This slide lists the faculty who were involved in the production of these slides.

2017 Myeloma Interactive Decision Support Tool
Developed by panel of 5 MM experts based on key factors they considered important to guide therapy Enter specific patient characteristics using drop-down menus MM, multiple myeloma. Slide credit: clinicaloptions.com clinicaloptions.com/myelomatool

Latest Approved Agents and Regimens for Relapsed/ Refractory Myeloma
Treatment Number of Previous Lines of Therapy Carfilzomib (IV proteasome inhibitor) + lenalidomide + dexamethasone* 1-3 Ixazomib (PO proteasome inhibitor) + lenalidomide + dexamethasone ≥ 1 Panobinostat (PO HDAC inhibitor) + bortezomib + dexamethasone ≥ 2 Elotuzumab (IV SLAMF7-targeted antibody) + lenalidomide + dexamethasone Daratumumab (IV CD38-targeted antibody) monotherapy ≥ 3 Daratumumab (IV CD38-targeted antibody) + dexamethasone + either lenalidomide or bortezomib Daratumumab (IV CD38-targeted antibody) + dexamethasone + pomalidomide *Carfilzomib monotherapy 20/56 mg/m2 IV previously approved for relapsed/refractory myeloma. Slide credit: clinicaloptions.com

Latest Agents: Lenalidomide-Based Studies
Outcomes POLLUX DRd vs Rd[1] ASPIRE KRd vs Rd[2] ELOQUENT-2 ERd vs Rd[3,4] TOURMALINE-MM1 IRd vs Rd[5] PFS HR (95% CI) 0.37 ( ) 0.69 ( ) 0.73 ( ) 0.74 ( ) ORR, % 93 87 79 78 ≥ VGPR 76 70 34 48 ≥ CR 43 32 5 14 DoR, mos NE 28.6 20.7 20.5 OS HR (95% CI) 0.64 ( ) 0.79 ( ) 0.77 ( ) DoR, duration of response; DRd, daratumumab/lenalidomide/dexamethasone; ERd, elotuzumab/lenalidomide/dexamethasone; IRd, ixazomib/lenalidomide/dexamethasone; KRd, carfilzomib/lenalidomide/dexamethasone; NE, not estimable; Rd, lenalidomide/dexamethasone. Please note: the trials on this table are not direct comparisons. 1. Dimopoulos M, et al. EHA Abstract LB Stewart AK, et al. N Engl J Med. 2015;372: 3. Lonial S, et al. N Engl J Med. 2015;373: Dimopoulos MA, et al. Blood. 2015;126. Abstract Moreau P, et al. N Engl J Med. 2016;374: Slide credit: clinicaloptions.com

Latest Agents: PI-Based Studies
Outcomes ENDEAVOR Kd vs Vd[1] CASTOR DVd vs Vd[2] Panobinostat PVd vs Vd[3,4] Elotuzumab EVd vs Vd[5] PFS HR (95% CI) 0.53 ( ) 0.39 ( ) 0.63 ( ) 0.72 ( ) Median PFS, mos 18.7 NR 12.0 9.7 ≥ VGPR, % 54 59 28 36 ≥ CR, % 13 19 11 4 DoR, mos 21.3 NE 13.1 11.4 OS HR 0.79 ( ) 0.77 ( ) 0.94 ( ) 0.61 ( ) DoR, duration of response; DVd, daratumumab/bortezomib/dexamethasone; EVd, elotuzumab/bortezomib/dexamethasone; Kd, carfilzomib/dexamethasone; PI, proteasome inhibitor; PVd, pomalidomide/bortezomib/dexamethasone; Vd, bortezomib/dexamethasone. Please note: the trials on this table are not direct comparisons. 1. Dimopoulos MA, et al. Lancet Oncol. 2016;17: Palumbo A, et al. ASCO Abstract LBA San-Miguel JF, et al. Lancet Oncol. 2014;15: San-Miguel JF, et al. Blood. 2015;126. Abstract Jakubowiak A, et al. Blood. 2016;127: Slide credit: clinicaloptions.com

Factors in Selecting Treatment for Relapsed/Refractory Myeloma
Disease-related factors Duration of response to initial therapy High-risk vs low-risk status Molecular disease progression vs symptomatic progression Other comorbid conditions, pt frailty Treatment-related factors Previous therapy exposure (relapsed or refractory) Toxicity/tolerability of previous regimen (combination vs single agent) Mode of administration (ie, PO or IV) Cost and convenience (out-of-pocket copays for IV vs PO) PT PREFERENCE Slide credit: clinicaloptions.com

Case 1: 48-Yr-Old Woman With First Relapse Myeloma
Develops fatigue and recurrent upper respiratory infections late summer 2012 Paroxysmal pain during coughing involving the ribcage, back, and pelvis Noted to have pathologic fracture following a fall involving the right femur, late 12/12 Right hip arthroplasty, 1/13 Surgical pathology: hypercellular marrow with areas of bone remodeling, more than 90% infiltration of plasma cells Serum protein electrophoresis: IgG lambda monoclonal protein Nuclear medicine bone scan: increased uptake ribs, thoracic spine, right sacral wing, right femur, and shoulders CT imaging: nondisplaced fracture of posterolateral 8th, 9th, and 10th ribs; severe compression deformity T2 vertebral body Received two 4-day pulses of dexamethasone, 2/13-3/13 Bone marrow biopsy, 3/13

Case 1: 48-Yr-Old Woman With First Relapse Myeloma
Initiates lenalidomide, IV bortezomib, dexamethasone on DFCI Protocol , 3/13 Completes 3 cycles of induction therapy, 5/13 Repeat bone marrow biopsy, 5/13: mildly hypercellular with 5% clonal plasma cells Stem cell mobilization cyclophosphamide-filgrastim, 5/13-6/13 Resumes lenalidomide, bortezomib, and dexamethasone, 6/13 Completes 8 cycles of lenalidomide, bortezomib, and dexamethasone in total, 10/13 Converts to lenalidomide maintenance therapy, 11/13 Repeat bone marrow biopsy, 12/15: normal cellularity, with 5% dysmorphic plasma cells that are polytypic in terms of kappa and lambda expression Disease progression 1/17 with rise in the M-protein to 1.05 and lambda light chain to mg/L DFCI, Dana Farber Cancer Institute.

PANORAMA-1: Addition of Panobinostat to Vd—Subgroup Analysis
PANORAMA-1 subgroup analysis: pts with ≥ 2 previous treatments, including bortezomib and an IMiD FDA approved indication based on subgroup analysis 100 Median PFS, Mos (95% CI) HR (95% CI) 80 Pan + Vd Placebo + Vd 12.5 ( ) 4.7 ( ) 0.47 ( ) 60 PFS Probability (%) 40 IMiD, immunomodulatory drug; Pan, panobinostat; Vd, bortezomib/dexamethasone. 20 2 4 6 8 10 12 14 16 18 20 22 24 26 28 Mos Slide credit: clinicaloptions.com Richardson PG, et al. Blood. 2016;127:

Case 1: Treatment Recommendations
Slide credit: clinicaloptions.com clinicaloptions.com/myelomatool

Event-Free Probability (%) Mos Since Start of CyBorP/D
Bortezomib and Cyclophosphamide, With Prednisone or Dex, in R/R MM: Efficacy 100 Response, n (%) N = 95 ORR 66 (69) Clinical CR 16 (17) VGPR 25 (26) PR SD 22 (23) PD 7 (7) Not evaluable 1 (1) Event Type OS PFS 80 60 Event-Free Probability (%) 40 20 CyBorP/D, cyclophosphamide, bortezomib, prednisone/dexamethasone; Dex, dexamethasone; MM, multiple myeloma; PD, progressive disease; R/R, relapsed/refractory; SD, stable disease. 12 24 36 48 36 Mos Since Start of CyBorP/D Although 26 pts had prior bortezomib, responses and survival did not significantly differ vs bortezomib-naive pts Slide credit: clinicaloptions.com Reece DE, et al. Clin Lymphoma Myeloma Leuk. 2016;16:

Bortezomib/Pomalidomide/Dexamethasone in Relapsed/Refractory MM: Efficacy in Phase I/II
Outcome Pts Treated at MTD (N = 47) Std-Risk Pts (n = 28) Int-/High-Risk Pts (n = 19) Response, n (%) ORR 40 (85) 24 (86) 16 (84) sCR 3 (6) CR 6 (13) VGPR 12 (26) PR 19 (40) Median OS, mos NR Event free at 6 mos, % 100 Event free at 12 mos, % 94 95 92 Median PFS, mos (95% CI) 10.7 ( ) 16.3 9.5 Median DoR, mos (95% CI) 13.7 ( ) DoR, duration of response; Int, intermediate; MM, multiple myeloma; MTD, maximum tolerated dose; NR, not reached; sCR, stringent CR; Std, standard. Slide credit: clinicaloptions.com Lacy MQ, et al. ASH Abstract 304.

Case 2: 67-Yr-Old Man With Multiple Relapsed Myeloma
Develops fatigue and generalized weakness autumn 2012 Hospitalized 2/13 with hypercalcemia and renal failure Serum protein electrophoresis: 4.2 g/dL, IgA kappa monoclonal protein Serum free light chain assay: kappa 640 mg/L, kappa/lambda ratio 11 MRI spine, 2/13: compression fractures at T7, T11, L1, L2, and T7 with minimal retropulsion of T7 Initiates cyclophosphamide, IV bortezomib, and dexamethasone, 2/13 Fat pad biopsy, 2/13: negative for amyloid Completes 12 cycles of induction therapy with cyclophosphamide, IV bortezomib, and dexamethasone, 11/13

Case 2: 67-Yr-Old Man With Multiple Relapsed Myeloma
‎Transitions to single-agent IV bortezomib every other wk as maintenance therapy, 11/13 Evidence of disease progression in 12/13 on single-agent bortezomib maintenance Reverts to cyclophosphamide, bortezomib, and dexamethasone, 1/14‎ Cyclophosphamide, bortezomib, and dexamethasone as salvage therapy, 1/14- 9/14 Disease progression, 10/14 Initiates therapy with lenalidomide plus HDAC inhibitor on clinical trial, 11/14 Achieves complete response as best response to therapy Disease progression 11/16-12/16 based on increase in total IgA level, kappa light chain concentration, and IgA kappa M-protein level

Carfilzomib/Pomalidomide/Dexamethasone in Relapsed/Refractory Myeloma
PFS OS 100 Car-Pom-Dex (N = 32) Median PFS: 7.2 mos 100 Car-Pom-Dex (N = 32) Median OS: 20.6 mos 80 80 60 60 PFS (%) OS (%) 40 40 20 20 Car, carfilzomib; Dex, dexamethasone; Pom, pomalidomide. 3 6 9 12 15 18 21 24 27 30 33 36 3 6 9 12 15 18 21 24 27 30 33 36 Mos Mos Slide credit: clinicaloptions.com Shah JJ, et al. Blood. 2015;126:

Carfilzomib/Pomalidomide/Dexamethasone in Relapsed/Refractory Myeloma: Safety
Grade 3/4 Treatment-Emergent AEs, n (%) Pts (N = 32) Neutropenia 14 (44) Thrombocytopenia 7 (22) Anemia 6 (19) Pneumonia* 4 (13) Creatinine elevation 3 (9) Pulmonary embolism* 2 (6) 12 pts (38%) required dose reductions Pomalidomide: 7 (22%) Carfilzomib: 5 (16%) Discontinuations Disease progression: 22 (69%) AEs: 6 (19%) Withdrew consent: 3 (9%) *1 grade 5 in each. AE, adverse event. Slide credit: clinicaloptions.com Shah JJ, et al. Blood. 2015;126:

Dara and/or Pom Refractory Dara and Pom Refractory
Daratumumab/Pomalidomide/Dexamethasone in Relapsed/Refractory Myeloma: Responses Best Response, n (%) Dara and Pom Naive (n = 19) Dara and/or Pom Refractory (n = 22) Dara and Pom Refractory (n = 12) ORR 17 (89.0) 9 (40.9) 4 (33.3) sCR 7 (36.8) CR 1 (5.3) VGPR 3 (15.8) 1 (4.5) 1 (8.3) PR 8 (42.1) 8 (36.4) 3 (25.0) MR/SD 6 (50.0) PD 4 (18.2) 2 (16.7) Median cycles of tx, n (range) 15 (1-23) 3 (1-8) Dara, daratumumab; MR, minimal response; PD, progressive disease; Pom, pomalidomide; sCR, stringent CR; SD, stable disease; tx, treatment. Slide credit: clinicaloptions.com Nooka AK, et al. ASH Abstract 492.

Daratumumab/Pomalidomide/Dexamethasone in Relapsed/Refractory Myeloma: Safety
Grade 3/4 Treatment-Emergent AEs, n (%) Pts (N = 41) Neutropenia 17 (42) Anemia 12 (29) Thrombocytopenia 8 (20) Fatigue 2 (5) Dizziness Hypokalemia Upper respiratory tract infection Dyspnea 1 (3) AEs similar to those seen in phase I trial 56% of pts required dose reductions Pomalidomide: 46% 15% discontinued pomalidomide 5% previously intolerant Dexamethasone: 22% Daratumumab: 0% Hematologic AEs generally resolved with dose reduction AE, adverse event. Slide credit: clinicaloptions.com Nooka AK, et al. ASH Abstract 492.

Case 3: 78-Yr-Old Man With Relapsed Myeloma Refractory to Multiple Agents
Presentation with back pain, 11/09 Plain film of spine, compression deformities at T5, T8, and T9 SPEP 01/10: 3.9 g/dL IgA lambda monoclonal protein Bone marrow biopsy: hypercellular marrow with 80% of cellularity comprised of plasma cells Cytogenetics: normal β2-microglobulin: 5 mg/L, albumin 3.4 g/dL at diagnosis Initiated lenalidomide, bortezomib, dexamethasone and monthly bisphosphonate, 3/10

Case 3: 78-Yr-Old Man With Relapsed Myeloma Refractory to Multiple Agents
Course c/b colovesical fistula 5/10 with surgical repair/ostomy placement Systemic therapy (bortezomib/dexamethasone) reinitiated 7/10 Stem cell mobilization, 11/10 High-dose melphalan and ASCT, 11/10 Lenalidomide maintenance, 06/11 Slight increase in myeloma parameters, autumn 2014 Converts to lenalidomide plus weekly dexamethasone, 20 mg, 12/14 Disease progression, autumn 2015 Initiates salvage therapy with lenalidomide/bortezomib/dexamethasone, early 12/15 ASCT, autologous stem cell transplantation; c/b complicated by.

Ixazomib, Pomalidomide, and Dex in Highly Refractory, Poor-Risk Myeloma (Phase I/II)
Patients with myeloma who failed up to 5 prior regimens including a PI and lenalidomide (N = 32) All pts received pomalidomide 4 mg and dex 40 mg; 7 received ixazomib 3 mg, and 25 ixaxomib 4 mg Response With Ixazomib 4 mg n = 25 ORR, % 48 Clinical benefit rate, % 76 Best response, n (%) VGPR 5 (20) PR 7 (28) MR 1 (4) SD 6 (24) PD Completed cycles, n (range) 4 (1-14) Median DoR, days (range) 210 (84-395) Response in High-Risk Pts n = 12 ORR, % 58 Clinical benefit rate, % 83 Best response, n (%) VGPR 3 (25) PR 4 (33) MR 1 (8) SD 2 (17) PD Anemia Neutropenia Thrombocytopenia Cardiac Nausea Other GI Fatigue Infections Metabolic abnormalities General muscle weakness Nervous system Dyspnea Skin, subcutaneous tissue Gr 1 Gr 2 Gr 3 Gr 4 Dex, dexamethasone; DoR, duration of response; GI, gastrointestinal; Gr, grade; MR, minimal response; PD, progressive disease; PI, proteasome inhibitor; SD, stable disease. 2 4 6 8 10 Slide credit: clinicaloptions.com Krishnan A, et al. ASH Abstract 3316.

Elotuzumab + Pom/Dex in Relapsed/Refractory Myeloma (Phase II): Initial Safety Data
Interim results from ongoing study in pts who are relapsed/refractory to lenalidomide (N = 53) Primary endpoint: PFS Secondary endpoints: OS, ORR, safety At time of report, 41 pts (77%) remain on treatment 2 grade 5 AEs: pneumonia/cardiac arrest, pneumococcal sepsis Serious AEs in 12 pts (23%): pneumonia, urinary tract infection, hypercalcemia Grade 1/2 infusion reactions in 3 pts Overall, safety profile consistent with elotuzumab, lenalidomide, and dexamethasone AEs in ≥ 15%, % N = 53 Fatigue 36 Cough 19 Anemia Diarrhea 17 Constipation 15 Neutropenia Thrombocytopenia AE, adverse event; Dex, dexamethasone; Pom, pomalidomide Slide credit: clinicaloptions.com Jagannath S, et al International Myeloma Workshop. Abstract PS-228.

Case 4: 66-Yr-Old Man With Relapsed Myeloma
Persistent anemia noted winter 2011 Serum protein electrophoresis, 2/11: 2.7 g/dL, IgG kappa monoclonal protein Quantitative immunoglobulins, 2/11: elevated IgG with reciprocal decrease in IgA and IgM Bone marrow biopsy, 2/11: 70% cellular marrow, 60% to 70% comprising monotypic, dysmorphic plasma cells Cytogenetics and FISH: hyperdiploid with multiple trisomies Skeletal bone survey: no lytic bone lesions, vertebral body compression fractures noted 24-hr urine, 2/11: 33 mg total protein with a faint IgG kappa M-protein β2-microglobulin 4.1 mg/L, albumin 3.8 g/dL at diagnosis Initiates lenalidomide, bortezomib, and dexamethasone, 3/11

Case 4: 66-Yr-Old Man With Relapsed Myeloma
Converted to lenalidomide and dexamethasone 5/11 due to concern for bortezomib-induced dizziness Stem cell mobilization and collection with cyclophosphamide and filgrastim, 7/11 High-dose melphalan 200 mg/m2 and ASCT, 7/11 Disease progression, 2/13-3/13 Initiate salvage therapy with lenalidomide 10 mg Days 1-21 over 28-day cycle plus weekly dexamethasone 20 mg Transitions to alternative dosing schedule in 2016 such that lenalidomide given 10 mg/day on Days 1-14 and every other day on Days of 28-day cycle Modest increase in myeloma laboratory parameters noted spring 2017, leading to modification in chemotherapy schedule such that lenalidomide administered at 10 mg on Days 1-21 of each 28-day cycle with dexamethasone 12 mg once weekly ASCT, autologous stem cell transplantation.

Case 5: 72-Yr-Old Woman With Relapsed MM, Comorbidities, and Lenalidomide Intolerance
Development of back pain and sciatica, summer 2012 Anemia noted 7/12 with hemoglobin 10 g/dL, hematocrit 34% Serum protein electrophoresis: IgA kappa monoclonal protein Quantitative immunoglobulins 7/12: IgA 5,218 mg/dL, IgG 204, IgM 16 Serum free light chain assay 7/12: kappa 1.7 mg/L, lambda 840, kappa/lambda Bone marrow biopsy 7/12: hypercellular, with 90% infiltration of clonal, lambda restricted plasma cells Metaphase cytogenetics: normal male karyotype FISH analysis: monosomy 13 in addition of chromosomal material at chromosome 1q β2-microglobulin 4.9 mg/L, albumin 4 g/dL at diagnosis

Metastatic bone survey, 7/12: diffuse lytic lesions involving the skull, cervical spine, thoracic spine, and humeri MRI of the cervical spine, 7/12: infiltrated bone marrow process with plasmacytoma or spinal cord involvement Initiates bortezomib/dexamethasone, early 9/12 Converts to lenalidomide, bortezomib, and dexamethasone, mid-9/12 Lenalidomide discontinued after 4 doses of therapy due to severe hypersensitivity reaction Received 2 additional cycles of bortezomib and dexamethasone, 10/12-11/12 Discontinues bortezomib due to treatment-related peripheral neuropathy, 12/12 Observed without therapy until 4/13

Stem cell mobilization with plerixafor-filgrastim, 3/13 High-dose melphalan 200 mg/m2 and ASCT, 3/13 Post-ASCT course c/b septic VTE involving R IJ requiring ICU hospitalization, IV antibiotics, and anticoagulation Disease progression autumn 2015 with increase in lambda light chain concentration to 220 mg/L Initiates salvage therapy with SC bortezomib 1.3 mg/m2 and dexamethasone 20 mg on Days 1, 8, and 15 of 28-day cycle, 10/15 Due to disease progression with increase in M-protein, total IgA level, and lambda light chain concentration, transitions to new regimen of daratumumab, 12/16 ASCT, autologous stem cell transplantation; c/b, complicated by; ICU, intensive care unit; IJ, internal jugular; VTE, venous thromboembolism;

Current Myeloma Treatment: Key AEs and Management Considerations
Drug Class Agent Key Potential AEs Management Considerations Proteasome inhibitors Bortezomib PN, T, M, F IV, SC; monitor platelets; safe in renal failure Carfilzomib PN, C, M, F, DVT Hydration, cardio/pulmonary Ixazomib PN, T, GI, R Reduce dose for hepatic/renal disease Immunomodulatory agents Lenalidomide DVT, M, BD, R, D ASA or LMWH if high risk for clots; weekly CBC x 8 wks Thalidomide DVT, M, BD As above Pomalidomide DVT, M, BD, F Monoclonal antibodies Daratumumab IR, M, RD Infusion reaction risk; pre/post med as directed; interrupt infusion if reaction Elotuzumab AE, adverse event; ASA, aspirin; BD, birth defects; C, cardiac; CBC, complete blood count; D, diarrhea; DVT, deep vein thrombosis; F, fatigue; IR, infusion reaction; GI, gastrointestinal toxicities (nausea, diarrhea, vomiting, constipation); LMWH, low-molecular-weight heparin; M, myelosuppression; MM, multiple myeloma; N, nausea; PN, peripheral neuropathy; R, renal dose adjustment necessary; RD, response disruption (mAbs can disrupt M protein assays, indicating potential lack of response); T, thrombocytopenia. Slide credit: clinicaloptions.com US Food and Drug Administration. FDA approved drug products.

Phase II SIRIUS: Daratumumab Monotherapy in Refractory Myeloma
Change in Paraprotein From Baseline 100 35 75 ORR: 29% 30 50 25 25 20 ORR (%) Maximum Change From Baseline (%) 15 -25 10 -50 5 -75 -90 16 mg/kg -100 Lonial S, et al. Lancet. 2016;387: Lonial S, et al. ASCO Abstract LBA8512. Slide credit: clinicaloptions.com

Promising Agents in Clinical Trials for Myeloma
MoA Phase in Development Pembrolizumab PD-1 antibody III Ibrutinib Tyrosine kinase inhibitor Oprozomib Proteasome inhibitor Selinexor XPO1 inhibitor Isatuximab CD38 antibody Venetoclax Selective BCL-2 inhibitor Filanesib Kinesin spindle protein inhibitor II MOR202 I/II Indatuximab ravtansine CD138 antibody–drug conjugate Ricolinostat HDAC inhibitor Durvalumab PD-L1 antibody MoA, mechanism of action. Slide credit: clinicaloptions.com ClinicalTrials.gov.

Conclusions Current treatment plans should be developed for each pt on an individual basis Pts with relapsed/refractory multiple myeloma now have an abundance of available therapeutic options, including bortezomib-, carfilzomib-, lenalidomide-, pomalidomide-, and daratumumab-based combinations Even with these advances, pts still relapse and there is no cure A new generation of promising agents and optimal combination regimens are being investigated in ongoing clinical trials, with hope for greater advances in treating pts with relapsed/refractory myeloma

Go Online for More CCO Coverage of Multiple Myeloma!
2017 Myeloma Interactive Decision Support Tool at: clinicaloptions.com/myelomatool Interactive case studies of myeloma management Additional CME-certified slidesets on multiple myeloma with expert faculty commentary on all the key studies clinicaloptions.com/oncology

Focus on Multiple Myeloma: Expert Insights and Strategies for Refining Patient Care This activity is supported by educational grants from Amgen; Celgene.

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