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What’s New in Multiple Myeloma Treatment

Medically Reviewed by Melinda Ratini, DO, MS on June 27, 2022

Treatments for multiple myeloma have grown a great deal in the past few years. Newer drugs help people with this blood cancer live longer and enjoy a better quality of life.

Several drugs have been approved to treat multiple myeloma since 2015. Some can help when the disease comes back after treatment (called a relapse) or when the cancer doesn’t respond to the first line of treatment (called refractory multiple myeloma).

Some of these newer drugs are:

Belantamab mafodotin-blmf (Blenrep) is the first in a class of drugs called antibody drug conjugates (ADC). These meds combine a monoclonal antibody drug and chemotherapy in one drug. Belantamab mafodotin-blmf can treat people who’ve been already treated with at least four prior therapies, including:

  • An anti-CD38 monoclonal antibody like daratumumab (Darzalex). This targets a protein on the surface of myeloma cells called CD38.
  • A proteasome inhibitor like bortezomib (Velcade). This drug blocks substances called proteasomes, which help cancer cells recycle proteins they need to grow.
  • An immunomodulatory agent. These meds use your body’s defenses (your immune system) to attack myeloma cells. Examples of these drugs are lenalidomide (Revlimid), pomalidomide (Pomalyst), and thalidomide (Thalomid).

Belantamab mafodotin-blmf targets the protein BCMA (B-cell maturation antigen), which is the protein that protects the cancer cell. 

Ciltacabtagene autoleucel (Carvykti) is a type of CAR-T therapy. That means it uses cells from your immune system to fight cancer. Ciltacabtagene autoleucel can treat adults with relapsed or refractory multiple myeloma who’ve had four or more different types of treatment, including:

  • A proteasome inhibitor
  • An immunomodulatory agent
  • And an anti-CD38 monoclonal antibody 

Each dose of the treatment is tailored for you using your own T cells -- a type of disease-fighting white blood cell – to help attack the myeloma. Your treatment team collects and genetically changes your T cells, then puts them back into your body.

Daratumumab (Darzalex) is a monoclonal antibody. It revs up your immune system to help you fight the cancer.

You can take this drug either alone or combined with bortezomib (Velcade), melphalan (Alkeran), and prednisone – or with dexamethasone and lenalidomide (Revlimid). It depends on whether you’re newly diagnosed, prior treatments haven’t helped you, or the disease has relapsed.

Daratumumab targets a protein on the surface of myeloma cells called CD38. It seeks out the protein and then kills the cancer cells it’s attached to.

Elotuzumab(Empliciti) is another monoclonal antibody.  It searches for a molecule on cancer cells called SLAMF7.

It’s combined with other myeloma drugs: either with lenalidomide (Revlimid) and dexamethasone, or with dexamethasone and a newer drug called pomalidomide (Pomalyst). It works for people with more aggressive forms of myeloma.

Idecabtagene vicleucel (Abecma) was the first CAR-T therapy to treat adults with multiple myeloma. It’s for people who haven’t responded to -- or whose disease has come back after -- at least four different types of treatment.

Isatuximab (Sarclissais a monoclonal antibody that works similar to daratumumab. It’s used together with pomalidomide and dexamethasone for people who’ve tried at least two other treatments. It also targets CD38 and slows the growth of cancer. It can also be used with carfilzomib (Kyprolis) and dexamethasone, to treat people who have tried one to three other treatments.

Ixazomib (Ninlaro) is the first and only oral proteasome inhibitor taken by mouth that the FDA has approved for multiple myeloma. Proteasomes are enzyme complexes that help cancer cells recycle proteins they need to grow. Ixazomib blocks proteasomes to kill myeloma cells.

It's combined with lenalidomide (Revlimid) and dexamethasone. It's used in people who’ve tried at least one other myeloma treatment.

Selinexor(Xpoviois a newer type of multiple myeloma drug called a selective inhibitor of nuclear export (SINE). It works by blocking XPO1, a protein that allows cancer cells to thrive.

The FDA approved selinexor for treatment of relapsed or refractory disease. It’s combined with dexamethasone and is used to treat people who've tried at least four previous treatments. It can also be used with dexamethasone or bortezomib in people who have tried at least one other treatment.

What’s on the Horizon?

Some potential breakthroughs in multiple myeloma therapy are still in the test phase, but they seem very promising, says Hans C. Lee, MD, an assistant professor at the University of Texas MD Anderson Cancer Center in Houston.

For example, T-cell engagers are antibodies that fight cancer cells in two separate ways: They look for BCMA and T cells, which are part of your own immune system, Lee says.

One arm of the antibody searches for BCMA on the myeloma cell’s surface. The other arm looks for a protein called CD3 on T cells. Lee says it’s basically “the kiss of death” for the cancer cells. The T cell is activated (turned on), it comes into contact with the myeloma cell, then kills it, he says. These drugs are also called bispecific T-cell engager antibodies, or BiTEs.

Another positive step for multiple myeloma treatment is the advance in genomic medicine, says Lee. Doctors are able to do a biopsy, or tissue sample, and see gene-related information about your cancer more quickly and cheaply than in the past. Lee says that hopefully, doctors will soon be able to use this data in real time, possibly to help find the ideal way to sequence your treatments or even to individualize treatment.

Show Sources

SOURCES:

National Cancer Institute: "Stopping Multiple Myeloma with New Treatments," "Pomalidomide for Multiple Myeloma," "Drugs Approved for Multiple Myeloma," "New Use for Lenalidomide in Multiple Myeloma."

Up to Date: “Patient education: Multiple myeloma treatment (Beyond the Basics).”

Hans C. Lee, MD, assistant professor, University of Texas MD Anderson Cancer Center.

Blood: “Safety and efficacy of selinexor in relapsed or refractory multiple myeloma and Waldenstrom macroglobulinemia.”

FDA: “FDA grants accelerated approval to selinexor for multiple myeloma,” “FDA Approves First Cell-Based Gene Therapy for Adult Patients with Multiple Myeloma,” “FDA approves ciltacabtagene autoleucel for relapsed or refractory multiple myeloma.”

Mayo Clinic: “Monoclonal antibody drugs for cancer: how they work.”

Drugs: "Elotuzumab: A Review in Relapsed and/or Refractory Multiple Myeloma."

The New England Journal of Medicine: “Elotuzumab Plus Pomalidomide and Dexamethasone for Multiple Myeloma.”

National Cancer Institute: “FDA Approves New Use for Daratumumab in Multiple Myeloma,” “FDA Approves Panobinostat for Some Patients With Multiple Myeloma.”

International Myeloma Foundation: “Darzalex (Daratumumab),” “Ninlaro (Ixazomib),” “Belantamab mafodotin anti-BCMA ADC.”

Multiple Myeloma Research Foundation: “Standard Treatments.”

Frontiers in Immunology: “Therapeutic Bi-specific T-cell Engager Antibody Targeting the Transferrin Receptor.”

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