Director, Translational Research, B-Cell Malignancy Program
Vice Chair of Clinical Affairs
Associate Professor of Hematology and Medical Oncology
Emory University School of Medicine
Winship Cancer Institute
Atlanta, Georgia
Side Effects of Emerging Therapies
People often ask, what are some of the more common side effects associated with some of the new treatment options that we have for patients with relapsed and refractory myeloma? And I think that there are a couple that we should pay particular attention to. When we think about drugs like pomalidomide, which is a derivative of thalidomide and lenalidomide, the most commonly seen side effects include myelosuppression and fatigue, and those are not too dissimilar from what we see with the use of the other IMiDs, thalidomide or lenalidomide. Another class of agents that is being explored in myeloma are the histone deacetylase inhibitors, or HDAC inhibitors, and the two drugs most prominent in that area are vorinostat and panobinostat, and both of these have some associated thrombocytopenia which appears to be a class effect. They also appear to have associated with them some GI toxicity, nausea, vomiting, diarrhea, and again fatigue is often seen with these agents as well. For the next generation of proteasome inhibitors, again fatigue continues to be a part of the issue that we see in subsets of patients as well as some minimal GI toxicity that is associated with agents such as carfilzomib. Those are probably the highest likelihood of agents that are moving to clinical approval in the near future. The last one that I think is worth touching just a bit on is the antibody elotuzumab, and in the antibody elotuzumab, as with other monoclonal antibodies, the most commonly seen side effect appears to be infusion reactions that can be mitigated through the use of premedication such as Benadryl, H2 blockers, and corticosteroids.
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