Expert Opin Pharmacother. 2013 Aug;14(12):1569-73. doi: 10.1517/14656566.2013.805746. Epub 2013 May 31.
The introduction of autologous stem cell transplantation as well as novel agents such as proteasome inhibitors (bortezomib) and immunomodulatory drugs (IMiDs; thalidomide and lenalidomide) have significantly improved long-term outcome of multiple myeloma patients. However, patients with high-risk disease at diagnosis had less benefit from these new strategies. In addition, myeloma patients with lenalidomide and bortezomib double-refractory disease have a very poor survival.
Several next generation novel agents are active in patients with double-refractory disease including carfilzomib and pomalidomide. Various monoclonal antibodies are also promising in the setting of relapsed/refractory disease, including daratumumab, elotuzumab and lorvotuzumab mertansine. This editorial will focus on the most promising next generation novel agents for the treatment of multiple myeloma.
Incorporation of these new novel agents in frontline therapies will lead to more effective and less toxic combination therapies. Furthermore, new diagnostic techniques such as gene-expression profiling and next-generation sequencing will hopefully result in more personalized treatments for molecularly-defined subgroups.
自体干细胞移植的引入以及蛋白酶体抑制剂（硼替佐米）和免疫调节药物（IMiDs；沙利度胺和来那度胺）等新型药物的出现，显著改善了多发性骨髓瘤患者的长期预后。然而，诊断时患有高危疾病的患者从这些新策略中获益较少。此外，对来那度胺和硼替佐米均耐药的多发性骨髓瘤患者的生存情况非常差。
几种下一代新型药物在双重耐药疾病患者中具有活性，包括卡非佐米和泊马度胺。各种单克隆抗体在复发性/难治性疾病中也很有前途，包括达雷妥尤单抗、埃罗妥珠单抗和洛莫司汀单抗。本社论将重点介绍治疗多发性骨髓瘤最有前途的下一代新型药物。
将这些新型药物纳入一线治疗方案将产生更有效、毒性更小的联合治疗方案。此外，新的诊断技术，如基因表达谱分析和下一代测序，有望为分子定义亚组的患者提供更个体化的治疗。
