Novel drug combinations for the management of relapsed/refractory multiple myeloma

The outcomes and management of multiple myeloma (MM) in the United States have changed dramatically over the past 15 years with the approval by the US Food and Drug Administration (FDA) of 6 new drugs (thalidomide, lenalidomide, bortezomib, pegylated liposomal doxorubicin [Doxil], carfilzomib, and pomalidomide). Despite these advances, a majority of patients with MM relapse, requiring subsequent lines of therapy to manage their disease as a chronic condition. Even though oncologists recognize the heterogeneity in the biology and clinical presentation of patients with newly diagnosed MM, clinical investigations still approach MM in a one-size-fits-all manner. The clinical management becomes even more challenging for relapsed/refractory MM, in which the clinician is balancing disease biology, disease burden, host factors, and financial limitations. There are several new drug targets and antibodies making their way through clinical development, but clinical trials remain an important avenue for patients with relapsed/refractory MM. The present review highlights some of the novel agent combinations in clinical trials that include the 2 most recently approved anti-MM agents, carfilzomib and pomalidomide, and looks ahead toward new drugs and targets in myeloma.