In the modern era of multiple myeloma therapeutics, proteasome inhibitor (PI) and immunomodulatory drugs (IMiDs) have replaced chemotherapy regimens for newly diagnosed multiple myeloma patients. Treatment combinations that comprise both first- and next-generation PIs, including bortezomib, carfilzomib, and ixazomib and IMiDs, including thalidomide and lenalidomide, have been evaluated in phases II and III clinical trials and have shown significant efficacy with manageable toxicity profiles. Bortezomib or carfilzomib with lenalidomide and dexamethasone (VRD and KRD) are the most promising regimens resulting in significant survival improvement. Disease and patient characteristics should lead the individualization of treatment, with the eligibility for autologous transplant being of principal importance. The addition of a monoclonal antibody to PI with IMiD combinations is currently under clinical investigation and may lead to further treatment optimization.
From the Department of Clinical Therapeutics, Alexandra General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Conflicts of Interest and Source of Funding: I.N.-S. reports no conflict of interest. E.T. has received honoraria from Amgen, Takeda, Genesis, Janssen, and Celgene. M.A.D. has received honoraria from Amgen, Takeda, Genesis, Janssen, Celgene, and BMS.
Reprints: Meletios A. Dimopoulos, MD, PhD, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, 80 Vas. Sofias Ave 11528, Athens, Greece. E-mail: mdimop@med.uoa.gr.
