Newest Treatments for Triple-refractory Multiple Myeloma Patients
Triple-refractory multiple myeloma patients are refractory to an immunomodulatory agent, a proteasome inhibitor and an anti-CD38 monoclonal antibody and represent a major unmet need. Two novel agents are FDA approved for patients treated with at least four prior therapies: selinexor, a small molecule nuclear export inhibitor approved in July 2019 and belantamab mafodotin, an antibody-drug conjugate targeting the B-cell maturation agent (BCMA) approved in August 2020.
In STORM, a pivotal trial evaluating selinexor combined with dexamethasone, the overall response rate (ORR) was 25% and the median duration of response was 3.8 months. Selinexor’s label has warnings and precautions for thrombocytopenia, neutropenia, gastrointestinal toxicity, hyponatremia, infections, neurological toxicity and embryo-fetal toxicity. In the DREAMM-2 pivotal trial, belantamab mafodotin reported an ORR of 32%, a median duration of response of 11 months and a median survival of 14.9 months. The belantamab mafodotin label has a black box warning for ocular toxicity and is only available through a risk evaluation and mitigation strategy (REMS) program. In addition, the belantamab mafodotin label has warnings and precautions for thrombocytopenia, infusion-related reactions and embryo-fetal toxicity.
How do you expect your prescribing practices to change in the future as a result of these recent approvals? Where do you foresee them fitting into your treatment algorithm?