Multiple Myeloma Clinical Research Clinical Director
H. Lee Moffitt Cancer & Research Institute
Tampa, Florida, USA
by Lynne Lederman, PhD
Toxicities associated with novel agents include thromboembolic events (TE) or hypercoagulable states, neurologic toxicities, hematologic toxicities, and skin reactions. TE are associated with the use of the IMiDs thalidomide and lenalidomide, but are also associated with untreated amyloid and MGUS as well as with multiple myeloma. Studies suggest that the use of bortezomib might eliminate the risk of TE. Further study is needed to compare low dose aspirin with low molecular weight heparin as prophylaxis against TE. Neurologic and hematologic toxicities associated with bortezomib or the IMiDs may require dose reduction and/or less frequent doses. Skin reactions may be non-symptomatic, requiring monitoring and allowing continuation of myeloma therapy, or symptomatic, requiring discontinuation of myeloma therapy and treatment of the symptoms. Dr. Hussein commented that the patient must be viewed as a whole, and can’t be ignored while only the disease is targeted. He agreed with a comment from Dr. Berenson that peripheral neuropathy associated with bortezomib was manageable and reversible, and that new agents could be used treat symptoms.