Nooka Ajay K, Lonial Sagar
From the Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA.
Am Soc Clin Oncol Educ Book. 2016;35:e431-41. doi: 10.1200/EDBK_159516.
Advances in the treatment of multiple myeloma have resulted in dramatic improvements in outcomes for patients. The newly emerging profiling of mutations emerging as a consequence of large prospective sequencing studies such as the CoMMpass Study or other efforts from European investigators are not further helping to define the place and role for personalized medicine in myeloma. While mutations such as NRAS, KRAS, and BRAF do occur in myeloma, it is not clear that targeting them as a single drug strategy will result in meaningful responses or durations of response. Personalized medicine in multiple myeloma at this time likely entails the use of risk-based approaches for maintenance therapy, the use of current biology-based treatments such as proteasome inhibitors, and immunomodulatory agents, with an eye towards the use of mutation-specific treatments in the setting of minimal residual disease or in concert with biology-based treatments overall.
多发性骨髓瘤治疗方面的进展已使患者的治疗效果得到显著改善。像CoMMpass研究这样的大型前瞻性测序研究或欧洲研究者的其他工作所带来的新出现的突变谱分析，并未进一步有助于明确个性化医疗在骨髓瘤中的地位和作用。虽然NRAS、KRAS和BRAF等突变确实在骨髓瘤中出现，但尚不清楚将它们作为单一药物策略进行靶向治疗是否会带来有意义的反应或反应持续时间。目前，多发性骨髓瘤的个性化医疗可能需要采用基于风险的维持治疗方法，使用如蛋白酶体抑制剂和免疫调节剂等当前基于生物学的治疗方法，并着眼于在微小残留病情况下或与整体基于生物学的治疗协同使用针对特定突变的治疗方法。
