Multiple myeloma is currently considered a chronic, incurable cancer, but several new treatment options approved over the last couple of decades have led to dramatically extended lifespans for many people with the disease. Now, a new meta-analysis of phase 3 trials in multiple myeloma has attempted to score these regimens on efficacy, cost, and safety with the aim of helping guide health care providers on suitable treatment options for patients.

“Despite the significant therapeutic advancements, multiple myeloma continues to remain an incurable disease,” said Binod Dhakal, MD, MS, assistant professor of medicine in the division of hematology/oncology at the Medical College of Wisconsin, Milwaukee, and senior author of the study. “Especially in the setting of relapsed/refractory multiple myeloma, each relapse is associated with subsequent shorter duration of response,” he added.

Patients often receive several treatments during the course of their disease, eventually becoming progressively resistant to more and more treatment options. However, the range of drugs available for multiple myeloma currently is much greater than it was 2 decades ago, and people can live for extended periods of time with an excellent quality of life.

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“Prior to 2003, there were very few FDA approvals in the previous thirty years for multiple myeloma; in contrast, from 2003 to now, there have been 11 new drugs and more than 26 approvals,” said Paul Richardson, MD, clinical program leader and director of clinical research at the Jerome Lipper Multiple Myeloma Center at Dana-Farber Cancer Institute in Boston, Massachusetts.

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Before the 2000s, the mainstays of multiple myeloma treatment were alkylating agents and corticosteroids,2 but the introduction of new treatments such as proteasome inhibitors, immunomodulatory agents, and greater use of autologous hematopoietic stem cell transplantations3 has significantly improved survival.4

 “The main advance in the last few years has been the emergence of triplet combination regimens, which have almost uniformly been shown to improve upon outcomes of these patients compared to doublet regimens,” Robert Orlowski, MD, PhD, director of the myeloma section in the division of cancer medicine at MD Anderson Cancer Center in Houston, Texas. “A second advance has been the introduction of immunotherapeutics, such as elotuzumab and daratumumab, and this trend is continuing given the likely coming approvals of other immune therapeutics such as belantamab mafodotin and idecabtagene vicleucel,” he added.