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Myelomas

Current Multiple Myeloma Treatment Strategies with Novel Agents: A European Perspective

^aWilhelminenspital, Vienna, Austria; ^bAnkara University School of Medicine, Department of Haematology, Ankara, Turkey; ^cDepartment of Hematology, Hospital Clinic, Barcelona, Spain; ^dDivisione di Ematologia dell'Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Ospedale Molinette, Turin, Italy; ^eDepartment of Haematology, St. Bartholomew's Hospital, London, U.K.; ^fInstitute of Hematology and Medical Oncology, Seragnoli, Bologna, Italy; ^gDepartment of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece; ^hDepartment of Oncology, University Clinic Vienna, Vienna, Austria; ⁱUniversitätsklinik Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany; ^jService d'Hématologie, Centre Hospitalier Universitaire (CHU), Lille, France; ^kDepartment of Internal Medicine V, University of Heidelberg, Heidelberg, Germany; ^lCentre René Gauducheau Nantes, Nantes, France; ^mDivision of Oncology/Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland; ⁿDepartment of Oncology, University Hospital CHUV, Lausanne, Switzerland; ^oDepartment of Medicine/Hematology and Oncology, University of Münster, Münster, Germany; ^pHematology Scientific Center, Russian Academy of Medical Sciences, Moscow, Russia; ^qInstitute of Cancer Research, Royal Marsden Hospital, London, U.K.; ^rDepartment of Haematology, IRS-CSFU, University of Southern Denmark, Vejle Hospital, Vejle, Denmark; ^sDepartment of Hematology, University Hospital of Salamanca, Salamanca, Spain; ^tInstitute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tiqva, Israel; ^uAmmonite Systems Ltd., Faringdon, U.K.; ^vDepartment of Hematology, Erasmus Medical Center, Rotterdam, The Netherlands; ^wVU University Medical Center, Department of Haematology, Amsterdam, The Netherlands

Key Words. Multiple myeloma • Thalidomide • Bortezomib • Lenalidomide

Correspondence: Heinz Ludwig, M.D., Department of Medicine, Wilhelminenspital, Montleartstr. 37, 1160 Vienna, Austria. Telephone: 43-1491502101; Fax: 43-1491502109; e-mail: heinz.ludwig{at}wienkav.at

Received August 26, 2009; accepted for publication December 11, 2009; first published online in THE ONCOLOGIST Express on January 19, 2010.

Disclosures: Heinz Ludwig: Consultant/advisory role: ESMO; Honoraria: Amgen, Ortho Biotech; Research funding/contracted research: Mundipharma, Janssen-Cilag; Meral Beksac: Honoraria: Celgene, Janssen-Cilag; Joan Bladé: Honoraria: Celgene, Janssen-Cilag; Mario Boccadoro: Consultant/advisory role: Celgene, Janssen-Cilag; Research funding/contracted research: Celgene, Janssen-Cilag; Jamie Cavenagh: None; Michele Cavo: Honoraria: Celgene, Janssen-Cilag, Novartis; Meletios Dimopoulos: Honoraria: Ortho-Biotech, Millennium, Celgene; Johannes Drach: Honoraria: Celgene, Janssen-Cilag; Hermann Einsele: Honoraria: Celene, Ortho-Biotech; Thierry Facon: Consultant/advisory role: Janssen-Cilag, Celgene; Honoraria: Janssen-Cilag, Celgene; Hartmut Goldschmidt: Research funding/contracted research: Ortho-Biotech; Jean-Luc Harousseau: Honoraria: Celgene, Janssen-Cilag; Urs Hess: None; Nicolas Ketterer: None; Martin Kropff: Honoraria: Ortho-Biotech, Celgene; Larisa Mendeleeva: None; Gareth Morgan: None; Antonio Palumbo: Honoraria: Celgene, Janssen-Cilag; Torben Plesner: Honoraria: Janssen-Cilag; Research funding/contracted research: Janssen-Cilag; Jesús San Miguel: Honoraria: Millennium, Celgene, Janssen-Cilag; Ofer Shpilberg: None; Pia Sondergeld: None; Pieter Sonneveld: Consultant/advisory role: ASH, Celgene, Janssen-Cilag; Sonja Zweegman: None.

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the independent peer reviewers.

The treatment of multiple myeloma (MM) has undergone significant developments in recent years. The availability of the novel agents thalidomide, bortezomib, and lenalidomide has expanded treatment options and has improved the outcome of patients with MM. Following the introduction of these agents in the relapsed/refractory setting, they are also undergoing investigation in the initial treatment of MM. A number of phase III trials have demonstrated the efficacy of novel agent combinations in the transplant and nontransplant settings, and based on these results standard induction regimens are being challenged and replaced. In the transplant setting, a number of newer induction regimens are now available that have been shown to be superior to the vincristine, doxorubicin, and dexamethasone regimen. Similarly, in the front-line treatment of patients not eligible for transplantation, regimens incorporating novel agents have been found to be superior to the traditional melphalan plus prednisone regimen. Importantly, some of the novel agents appear to be active in patients with high-risk disease, such as adverse cytogenetic features, and certain comorbidities, such as renal impairment. This review presents an overview of the most recent data with these novel agents and summarizes European treatment practices incorporating the novel agents.