The National Comprehensive Cancer Network (NCCN) has announced three major changes to its guidelines for the treatment of multiple myeloma (MM) that broaden the population of patients eligible to start therapy, utilize the Revised International Staging System, and include newer agents with evidence of improved outcomes.
The changes were presented at the NCCN Annual Meeting (March 31–April 2; Hollywood, FL) by Kenneth C Anderson, MD, professor at Harvard Medical School and Dana-Farber Cancer Institute and chair of the NCCN Multiple Myeloma/Systemic Light Chain Amyloidosis/Waldenström's Macroglobulinemia Panel.
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For the first time, asymptomatic patients will now be eligible to receive treatment under the revised guidelines. Earlier versions of the guidelines recommended that physicians wait until patients presented with calcium elevation, renal insufficiency, anemia, or bone abnormalities. Now, said Dr Anderson, it is no longer necessary to adapt a wait-and-see approach, and patients will have access to treatment sooner.
The basis for the other changes came after a comprehensive review of new research presented at the American Society of Hematology Annual Meeting as well as recent US Food and Drug Administration (FDA) approvals for MM therapies. After evaluating the relevant data, the panel made a number of significant recommendations including the addition of lenalidomide/bortezomib/dexamethasone as a category 1 preferred regimen.
In addition, ixazomib, which was approved by the FDA in November 2015, was also added to the guidelines for the first time as part of the triplet regimen of lenalidomide, ixazomib, and dexamethasone. This decision marks the first time a triplet regimen for initial therapy has consisted entirely of oral medications.
Two monoclonal antibodies, elotuzumab and daratumumab, were also added as new therapeutic options for those with relapsed multiple myeloma after showing improved progression-free survival and response rate compared with standards at the time.
The panel also endorsed revisions to the International Staging System in which a blood test for serum albumin and beta-2 microglobulin was used to assess prognoses and improve risk stratification for patients with MM. The revised staging system—developed in August of 2015—incorporates fluorescent in situ hybridization evidence of high-risk cytogenetics, which will help providers more precisely stage their patients.
Dr Anderson finished the session by citing the addition of immunotherapeutic drugs as well as new lines of proteasome inhibitors as signifying the remarkable progress for patients and providers, but added that the road does not stop there. “It’s been remarkable progress,” said Dr Anderson, “but the best is yet to come.”
