- An anti-CD38 monoclonal antibody like daratumumab (Darzalex). This targets a protein on the surface of myeloma cells called CD38.
- A proteasome inhibitor like bortezomib (Velcade). This drug blocks substances called proteasomes, which help cancer cells recycle proteins they need to grow.
- An immunomodulatory agent. These meds use your body’s defenses (your immune system) to attack myeloma cells. Examples of these drugs are lenalidomide (Revlimid), pomalidomide (Pomalyst), and thalidomide (Thalomid).
- A proteasome inhibitor
- An immunomodulatory agent
- And an anti-CD38 monoclonal antibody
Each dose of the treatment is tailored for you using your own T cells — a type of disease-fighting white blood cell – to help attack the myeloma. Your treatment team collects and genetically changes your T cells, then puts them back into your body.
You can take this drug either alone or combined with bortezomib (Velcade), melphalan (Alkeran), and prednisone – or with dexamethasone and lenalidomide (Revlimid). It depends on whether you’re newly diagnosed, prior treatments haven’t helped you, or the disease has relapsed.
Idecabtagene vicleucel (Abecma) was the first CAR-T therapy to treat adults with multiple myeloma. It’s for people who haven’t responded to — or whose disease has come back after — at least four different types of treatment.
Isatuximab (Sarclissa) is a monoclonal antibody that works similar to daratumumab. It’s used together with pomalidomide and dexamethasone for people who’ve tried at least two other treatments. It also targets CD38 and slows the growth of cancer. It can also be used with carfilzomib (Kyprolis) and dexamethasone, to treat people who have tried one to three other treatments.
The FDA approved selinexor for treatment of relapsed or refractory disease. It’s combined with dexamethasone and is used to treat people who’ve tried at least four previous treatments. It can also be used with dexamethasone or bortezomib in people who have tried at least one other treatment.
What’s on the Horizon?
Some potential breakthroughs in multiple myeloma therapy are still in the test phase, but they seem very promising, says Hans C. Lee, MD, an assistant professor at the University of Texas MD Anderson Cancer Center in Houston.