Sequential or Combination Therapy for Multiple Myeloma

Ajay Nooka; Sagar Lonial


Expert Rev Hematol. 2012;5(5):533-545. 

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Expert Commentary

The answer to the debate of sequential versus combination therapies is unknown, but what may strongly favor combination therapies is the evidence that myeloma cells follow Gompertzian kinetics and combination therapies are more likely to result in a greater fraction of tumor cells being destroyed at a given point, thereby minimizing residual tumor burden. Second, by using combination therapies, complementary mechanisms of action or induced oncogene addiction may in fact become more than a laboratory phenomenon, and may be a clinical reality, enhancing not only RR, but also clinical end points such as PFS and OS. Finally, we all know that major advances in oncology have occurred as a result of combination therapy (diffuse large cell lymphoma, Hodgkin Disease, germ cell tumors and so on), thus this approach, when the patient is not plagued with toxicity, represents a path by which we can hope to have the greatest success. Further preclinical and clinical trials that prove the efficacy of combination therapy are needed, and will likely be forthcoming in the near future.