Multiple Myeloma: Latest Research

Approved by the Cancer.Net Editorial Board, 05/2020

ON THIS PAGE: You will read about the scientific research being done to learn more about multiple myeloma and how to treat it. Use the menu to see other pages.

Doctors are working to learn more about myeloma, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options that are best for you. Below are some of the areas researchers are looking into. With the fast pace of myeloma research, you are encouraged to ask about available clinical trials.

  • New drugs. A variety of new drugs are being studied for the treatment of relapsed myeloma and relapsed, refractory myeloma, including the following examples. Many more are being studied.

    • B-cell maturation antigen (BCMA). BCMA is a marker on the plasma cells that can be targeted for the treatment of myeloma. Several treatments that target BCMA are under development. These include antibodies that bring cells of the immune system to destroy myeloma cells, antibody-drug conjugates, and chimeric antigen receptor (CAR) T-cell therapies. The experimental antibody-drug conjugate belantomab mafodotin uses an antibody to bind to BCMA and delivers chemotherapy to the myeloma cell. Antibody-drug conjugates have shown promising early results.

    • Melflufen. Melflufen is a more efficient formulation of the well-established drug melphalan. It is being studied in clinical trials to find out how effective it is, after promising results in early studies.

    • Venetoclax (Venclexta, Venclyxto). This BCL-2 inhibitor has been used to treat some types of lymphoma and leukemia, and there may be benefit to using it for myeloma with a specific genetic mutation that appears in about 20% of patients with myeloma.

    • MCL-1 inhibitors. This class of drug destroys cells in myeloma. These inhibitors are under active development.

    Myeloma represents a new treatment paradigm (a set of assumptions and practices) in cancer because the new drugs that target the tumor cell, tumor-bone marrow interaction, and bone marrow environment can overcome normal drug resistance. Drugs are first tested using clinical trials with patients with advanced myeloma and then used to treat patients with earlier-stage myeloma.

  • Drug combinations. Most myeloma cells will eventually become resistant to standard chemotherapy, a condition called multidrug resistance. New drugs and combinations of approved drugs are being researched to provide more options for patients with myeloma. Many new drug combinations have been developed and are being studied in various settings, including:

    • Bortezomib and lenalidomide in combination with dexamethasone

    • Bortezomib, cyclophosphamide, and dexamethasone

    • Carfilzomib, lenalidomide, and dexamethasone

    • Ixazomib, lenalidomide, and dexamethasone

    • Pomalidomide, bortezomib, and dexamethasone

    • Carfilzomib, pomalidomide, and dexamethasone

    • Pomalidomide, ixazomib, and dexamethasone

    • Pomalidomide, dexamethasone, and clarithromycin (Biaxin)

    • Daratumumab, bortezomib, dexamethasone

  • Immunotherapy. This type of therapy is designed to boost the body’s natural defenses to fight cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. Vaccines are a type of immunotherapy being explored in the treatment of multiple myeloma. Research on using these therapies to treat advanced myeloma is ongoing. Learn more about the basics of immunotherapy.

    • In CAR T-cell immunotherapy, the patient’s own immune cells are removed, modified to target their own myeloma cells, and then put back into the body to fight the myeloma. Clinical trials are studying various CAR T-cell therapies that target a protein found on myeloma cells known as B-cell maturation antigen (BCMA). Researchers are also examining the effectiveness of BCMA-targeted CAR T cells in combination with other treatments, as well as working to identify other antigens found on myeloma cells that may be effective immunotherapy targets.

    • Checkpoint inhibitor therapies include antibodies to block PD-L1 on multiple myeloma cells and PD-1 on immune cells. PD-1 is found on the surface of T cells, which are a type of white blood cell that directly helps body’s immune system fight disease. Because PD-1 keeps the immune system from destroying cancer cells, blocking PD-1 allows the immune system to better eliminate the disease. Current research is trying to work out which patients benefit most from these treatments and in which combinations of other drugs they should be used. The FDA stopped all clinical trials using PD-1 checkpoint inhibitors in multiple myeloma. In 1 study of combination therapy that included pembrolizumab (Keytruda), researchers saw an increased death rate. Other checkpoint inhibitors targeting LAG3 and TIM3 are under investigation.

    • New monoclonal antibodies such as immunotoxins and bi-pleuritic, also called bispecific T-cell engagers (BiTEs), target BCMA. BiTEs can attach to both a T cell and a myeloma cell at the same time, activating an immune attack on the cancer cells. Unlike CAR T cells, BiTES can be manufactured without removing a patient’s immune cells. Early-stage clinical trials are working to study BiTEs in multiple myeloma.

    • Vaccines are another type of immunotherapy being explored in the treatment of multiple myeloma.

  • Palliative care/supportive care. A limited number of clinical trials are underway to find better ways of reducing symptoms and side effects of current myeloma treatments to improve comfort and quality of life for patients.

Looking for More About the Latest Research?

If you would like additional information about the latest areas of research regarding myeloma, explore these related items that will take you outside of this guide:

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