Drugs presently used for prolonged therapy, including comments on their tolerance profile, activity in high-risk disease, effect on stroma compartments, synergistic activity, and route of administration
| Antimyeloma drug . | Factors potentially limiting feasibility of continuous therapy . | Activity in high-risk disease . | Impact on stroma . | Synergistic activity with . | Route of administration . |
|---|---|---|---|---|---|
| Dexamethasone | Hormonal side effects, psychological side effects | Limited evidence | Immunosuppressive | IMiDs and PIs | Oral |
| Thalidomide | Neuropathy | Reduces PFS and OS | Negative (shorter PFS after previous thalidomide exposure) | Dexamethasone | Oral |
| Lenalidomide | Second primary malignancies, hematological side effects | Some but less active than PI | Enhances several immune functions | PIs, dexamethasone, and MoAb | Oral |
| Bortezomib | Neuropathy, hematological and GI side effects, reactivation of latent viral infections | Yes | Inhibition of osteoclasts | IMiDs, dexamethasone, and MoAb | SC |
| Carfilzomib | Cardiac events, hematological side effects | Yes | Data n.a. but a class effect likely | IMiDs, dexamethasone, and MoAb | IV |
| Ixazomib | Few hematological and other side effects | Yes | Data n.a. but a class effect likely | IMiDs, dexamethasone and MoAb | Oral |
| Elotuzumab | Uncommon, usually grade 1 and 2 infusion reactions | Yes | Activates ADCC | IMiDs and PIs | IV |
| Daratumumab | Infusion reactions in ∼50% | Yes | Activates several immune functions | IMiDs and PIs | IV |
| Antimyeloma drug . | Factors potentially limiting feasibility of continuous therapy . | Activity in high-risk disease . | Impact on stroma . | Synergistic activity with . | Route of administration . |
|---|---|---|---|---|---|
| Dexamethasone | Hormonal side effects, psychological side effects | Limited evidence | Immunosuppressive | IMiDs and PIs | Oral |
| Thalidomide | Neuropathy | Reduces PFS and OS | Negative (shorter PFS after previous thalidomide exposure) | Dexamethasone | Oral |
| Lenalidomide | Second primary malignancies, hematological side effects | Some but less active than PI | Enhances several immune functions | PIs, dexamethasone, and MoAb | Oral |
| Bortezomib | Neuropathy, hematological and GI side effects, reactivation of latent viral infections | Yes | Inhibition of osteoclasts | IMiDs, dexamethasone, and MoAb | SC |
| Carfilzomib | Cardiac events, hematological side effects | Yes | Data n.a. but a class effect likely | IMiDs, dexamethasone, and MoAb | IV |
| Ixazomib | Few hematological and other side effects | Yes | Data n.a. but a class effect likely | IMiDs, dexamethasone and MoAb | Oral |
| Elotuzumab | Uncommon, usually grade 1 and 2 infusion reactions | Yes | Activates ADCC | IMiDs and PIs | IV |
| Daratumumab | Infusion reactions in ∼50% | Yes | Activates several immune functions | IMiDs and PIs | IV |
ADCC, antibody-dependent cytotoxicity; GI, gastrointestinal; IMiD, immunomodulatory agent; MoAB, monoclonal antibodies; n.a, not available; PI, proteasome inhibitor; SC, subcutaneous administration.