演題抄録

臓器別シンポジウム

開催概要
開催回
第58回・2020年・京都
 

多発性骨髄腫に対する分子標的治療戦略の理論とエビデンス

演題番号 : SY23-4

[筆頭演者]
黒田 純也:1 

1:京都府立医科大学・血液内科

 

Multiple myeloma (MM) is the second most popular hematologic malignancy. Cytogenetical and molecular features are highly complex and heterogenous among patients with MM. Moreover, the exposure to therapeutic insults and the immune attack accelerate the emergence of branch clones that can fit the tumor microenvironment and causes the eventual treatment failure. Accordingly, the prognosis of MM was dismal in the era of classical chemotherapy with genotoxic agents, however, the advent of therapeutic strategies targeting disease specific biologic characteristics, molecular abnormalities and immunologic dysregulation made great progress in establishing both universally promising approaches and patient-oriented treatment options according to molecular features, types of organ damage and vulnerability of individual patient. As of 2020, the combination therapies by anti-CD38 monoclonal antibody (MoAb) daratumumab and either the first-generation proteasome inhibitor (PI) bortezomib, an alkylator melphalan and prednisolone, or immunomodulatory drug (IMiD) lenalidomide and dexamethasone, are the current first-line standards of care for transplant ineligible newly diagnosed MM. Indeed, those have shown significant improvement of not only progression free survival but also overall survival. Many other agents are also available in salvage settings, such as the second-generation PIs carfilzomib and ixazomib, third-generation IMiD pomalidomide, and MoAbs elotuzumab against SLAMF7 and isatuximab against CD38. In addition, upcoming new agents, such as BCL2 inhibitor venetoclax or antibody-drug conjugates, are currently under clinical development. However, MM still remains mostly incurable, and the optimal choice from various treatment options is the key determinant for therapeutic outcome of individual patients. We in this symposium thoroughly review and discuss the theory and evidence which underlie the treatment decision making in MM treatment.

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