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Initial therapy in multiple myeloma: investigating the new treatment paradigm

Department of Pharmacy, University of Kansas Hospital, Kansas City, KS, USA

Karen L Finkbiner, PharmD

Department of Pharmacy, Lawrence Memorial Hospital, Lawrence, KS, USA

Susan E Klenke, RPh BCOP

Department of Pharmacy, University of Kansas Hospital, Kansas City, KS, USA

Ronald D Baker, PharmD

Department of Pharmacy, University of Kansas Hospital, Kansas City, KS, USA

Dave W Henry, MS BCOP FASHP

School of Pharmacy, University of Kansas, Lawrence, KS, USA

Casey B Williams, PharmD BCOP

Department of Pharmacy, University of Kansas Hospital, Kansas City, KS, USA, School of Pharmacy, University of Kansas, Lawrence, KS, USA, cwilliams9{at}kumc.edu

The development of three novel chemotherapeutic agents — thalidomide, lenalidomide, and bortezomib — has resulted in a fundamental shift in the management of multiple myeloma. Despite this tremendous advancement, the selection of initial treatment must still be made with a degree of uncertainty as a true standard therapy has yet to be established. Although challenging, the relative abundance of therapeutic options, when taken into consideration with unique patient characteristics, creates the potential for individualization of care.

For patients eligible for autologous stem cell transplantation, various combinations of novel agents with dexamethasone or traditional chemotherapy have supplanted the previous standard regimen consisting of vincristine, doxorubicin, and dexamethasone. In elderly patients or others that are deemed ineligible for the transplant procedure, the addition of a novel agent to melphalan-prednisone has demonstrated significant improvements in response rates. Due to the immaturity of the available data, it is perhaps best to regard the era of novel agents with a degree of rational enthusiasm, as the ultimate impact on patient care remains undetermined. Although further research is clearly implicated, recent advancements have resulted in significant progress toward obtaining optimum outcomes in a historically challenging disease.

Key Words: multiple myeloma • hematology • pharmacotherapy • review

This version was published on September 1, 2009

Journal of Oncology Pharmacy Practice, Vol. 15, No. 3, 131-141 (2009)
DOI: 10.1177/1078155208101096


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