In an open discussion with Targeted Oncology, Prerna Mewawalla, MD, talked about the standout therapies in the cancer of plasma cells (MM) space that have altered the landscape in the past ten years. Moreover, MD talked on how she goes about sequencing these therapies in different patients.Mewawalla, a medical director apheresis at the AHN or Allegheny Health Network, also focused on the outlook of treating multiple myeloma compared to ten years ago.
During discussion she uttered, "I believe each segment of therapy, whether it's oral, intravenous, or subcutaneous, we've noticed great outcomes. For instance, in the oral zone, of course, we've had lenalidomide forever, we have pomalidomide, while in the subcutaneous zone we have daratumumab, and we have medicines in the IV zone as well. So, I don't think the delivery specifies the efficacy as much, but I believe with the existence of more oral agents, it's more about convenience than efficacy".
"One of the things I do notice is the side effect profile, I do notice what are the patient comorbidities? Are patients going to tolerate this medicine if they have cardiac risk factors? What are we using carfilzomib in those patients, things like that".
"Another thing that I notice when it comes to sequencing medicines is what have patients had earlier? Are patients refractory to what they've had earlier? Are patients still sensitive to what they've had earlier, mainly in case they are lenalidomide sensitive vs lenalidomide refractory? In case they're lenalidomide sensitive, then I can still consider combinations like daratumumab, lenalidomide, and dexamethasone, but in case they're lenalidomide refractory, then I can consider daratumumab, bortezomib, and dexamethasone".
"So that is another factor which exists in choosing treatments. I also consider the biology of the disease while sequencing treatments. Am I tackling a bit high-risk aggressive disease, or am I just tackling a low-risk disease where the M spike is just occuring gradually? For instance, when I've a patient where it's just the M spike, and it's just progressing gradually, the drug elotuzumab is the best option to pick out in those scenarios as well".
"I believe scenarios have changed a lot for the treatment of multiple myeloma (MM). It's been a very exciting ten years for myeloma, we've had numerous biologic treatments available. Every certain time-span, we have a new medicine, which becomes available to us", MD also added.
