The role of proteosome inhibitors in multiple myeloma

Mohamad Mohty, MD, PhD, from Saint-Antoine Hospital, Paris, France, and President of the European Society for Blood and Marrow Transplantation (EBMT), talks about the a symposium hosted at the 2016 Annual Meeting of EBMT, held in Valencia, Spain, focusing on the role of proteosome inhibitors in multiple myeloma (MM). In the last 15 years, we have lived with the 1st generation proteosome inhibitors for the treatment of MM, mainly bortozemib. However, in the recent years the research community has developped 2nd generation proteosome inhibitors, such as carfilzomib and ixazomib. This symposium focused on the mechanistic aspects of these inhibitors in the context of MM, the different drug combinations containing proteosome inhibitors in relapsed/refractory MM (doublet vs triplet combinations), and the most recent results from trials containing proteosome inhibitors. The ASPIRE trial showed the superiority of a triplet combination of carfilzomib, lenalidomide and dexamethasone, compared to lenalidomide and dexamethasone., in terms of progression-free survival (PFS) in relapsed/refractory MM. The results of other 2 clinical trials of ixazomib, lenalidomide and dexamethasone vs lenalidomide and dexamethasone, and carfilzomib and dexamethasone vs bortozemib and dexamethasone, revealed the importance of these novel drugs in high-risk cytogenetics patients, as it is likely that 2nd generations drugs will have higher efficacy in this hard-to-treat group of patients.