Pharmacist-Guided Strategies for Treatment Resistance in MM and the Need for Multidisciplinary Care Teams

In a session at the new Great Debates & Updates Oncology Pharmacy virtual meeting, co-chair Kirollos Hanna, PharmD, BCPS, BCOP, reviews the current standard of care for relapsed/refractory multiple myeloma (MM), and provides strategies pharmacists can use to overcome treatment resistance in this patient population while highlighting the importance of a multidisciplinary care team in MM.  

Dr Hanna kicked off the session by explaining recent stats related to MM. There have been 34,920 new cases and 12,410 deaths in 2021. He said that the 5-year survival is 55.6% and the etiology is unknown. Further, he highlighted that there is currently no established guidelines for prevention and screening.

For patients diagnosed with MM, Dr Hanna said that this disease “remains incurable to date regardless of transplant eligibility.” He explained that triplet therapy is preferred for this patient population as it is linked with improved response rates, depth of response, and rates of progression-free survival. Additionally, he noted that the appropriate sequencing of this therapy option is critical in order to “optimize outcomes and subsequent treatment selection.”  

Dr Hanna has mentioned that supportive care is required for disease- and drug-specific events.  

Since the year 2000, there have been 14 drugs approved for the myeloma. Although there are a number of drugs approved, there are many factors in selecting treatment for relapsed MM, Dr Hanna noted. He explained that there are various disease- and treatment-related factors, as well as patient preference.  

• Some of the disease- and treatment-related factors include:
• High-risk vs low-risk status;
• Molecular disease progression vs symptomatic progression;
• Other comorbid conditions and patient frailty;
• Previous therapy exposure;
• Toxicity and tolerability of previous treatment regimen;
• Mode of administration; and
• Cost and convenience.

For patient preference, Dr Hanna said the “control may be more desirable than a cure at relapse.”

During the presentation Dr Hanna also highlighted the value multidisciplinary teams hold for the care and treatment of patients with MM.  

He explained that a care team can help manage bone disease, address myelosuppression and infection, as well as key adverse events in MM treatment. They can also help with drug-drug interactions along with dosing and other implications of various treatments. Finally, these care teams can identify interference with laboratory assays and provide guidance on various oral chemotherapy logistics and implications.