Related Experiment Video
Updated: May 16, 2026
An Organotypic High Throughput System for Characterization of Drug Sensitivity of Primary Multiple Myeloma Cells
Published on: July 15, 2015
Sequential or combination therapy for multiple myeloma
1Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA.
Abstract:
In myeloma management, whether to offer sequential or combination therapies has largely remained elusive, partly for the reason that there are no conclusive studies evaluating this question and partly owing to the paradigm shift in myeloma outcomes over the last decade raising the same question again, but now in a different context with active agents such as immunomodulatory drugs and proteasome inhibitors being available. Historically, in myeloma, combination cytotoxic chemotherapy compared with the standard-of-care melphalan and prednisone regimen resulted in similar response rates, raising the question of efficacy of the cytotoxic combination therapies with high toxicities and the preference for sequential therapies in order to lower the toxicity of the chosen treatment. However, with the use of more active novel agents with favorable toxicity profiles such as bortezomib, thalidomide and lenalidomide, re-evaluation of this question is necessary.
Insights
The optimal treatment strategy for myeloma, sequential versus combination therapy, remains unclear. Novel agents necessitate re-evaluating treatment approaches for improved outcomes in multiple myeloma management.
Area of Science:
- Oncology
- Hematology
- Pharmacology
Background:
- The optimal therapeutic strategy for multiple myeloma (MM), specifically sequential versus combination therapy, is a long-standing clinical question.
- Historically, combination cytotoxic chemotherapy showed limited benefit over standard melphalan and prednisone, favoring sequential approaches due to toxicity concerns.
- Recent advancements in MM treatment include novel agents like immunomodulatory drugs and proteasome inhibitors with improved toxicity profiles, necessitating a re-evaluation of treatment paradigms.
Purpose of the Study:
- To address the unresolved question of whether sequential or combination therapies are superior in managing multiple myeloma.
- To investigate the efficacy and safety of different therapeutic strategies in the context of novel agents.
- To provide evidence-based guidance for optimizing multiple myeloma treatment regimens.
Main Methods:
- A review of existing literature and clinical trials comparing sequential and combination therapies in multiple myeloma.
- Analysis of treatment outcomes, including response rates, progression-free survival, and overall survival.
- Evaluation of toxicity profiles associated with different therapeutic combinations and sequences.
Main Results:
- Conclusive studies directly comparing sequential and combination therapies in the context of novel agents are lacking.
- Historical data suggested limited efficacy gains from combination cytotoxic chemotherapy versus sequential approaches.
- Novel agents offer a new context for re-evaluating the balance between efficacy and toxicity in combination strategies.
Conclusions:
- The optimal sequencing or combination of novel agents in multiple myeloma requires further rigorous investigation.
- Re-evaluation of treatment strategies is crucial given the evolving therapeutic landscape and improved patient outcomes.
- Future research should focus on head-to-head comparisons of sequential versus combination regimens using current standards of care.
Related Concept Videos
02:50Combination Therapies and Personalized Medicine
The combination of the drug acetazolamide and sulforaphane is a good example of combination therapy to treat cancer. The cells in the interior of a large tumor often die due to the hypoxic and...
02:50Combination Therapies and Personalized Medicine
The combination of the drug acetazolamide and sulforaphane is a good example of combination therapy to treat cancer. The cells in the interior of a large tumor often die due to the hypoxic and...
02:57Targeted Cancer Therapies
There are several types of targeted therapies against specific...
02:49Cancer Therapies
However, cancer treatments can pose several challenges, as therapies used to kill cancer cells are generally also toxic to normal cells. Moreover, cancer cells mutate rapidly and can develop resistance to chemical agents or radiation therapy. Besides, all types of cancer cells may not respond to the same therapy. Some cancer cells respond to one...
02:56Treatment Resistant Cancers
01:27Tumor Immunotherapy