In what clinical scenarios do you utilize venetoclax-based therapy in relapsed/refractory multiple myeloma?

Topics: Hematologic Malignancies • Medical Oncology • Myeloma • NCI-CCC Tumor Board Question • Indiana University • NCI-CCC Myeloma Tumor Board Question

Venetoclax has demonstrated efficacy in patients harboring t(11;14) mutations but is not FDA approved for MM. Can you expand on what situations you may recommend this? What is your preferred dosing schedule/timing? Or combination therapy?

Answer from: Medical Oncologist at Community Practice

I would caution that there is no strong data that the combination of Venetoclax with a proteasome inhibitor or a CD38 antibody makes sense; in fact, the addition is more likely than not to cause harm. Adding on to Venetoclax in patients that are naive to proteasome inhibitor or CD38 Ab naive...

Comments

Medical Oncologist at University of Washington, Fred Hutchinson Cancer Research Center
Fair enough, and good point - so you would favor a...

Answer from: Medical Oncologist at Academic Institution

Disclaimer, before I comment, is that venetoclax is not FDA approved for myeloma and any use is off-label. The results for those with t(11;14) or high BCL2 expression are promising, but the phase 3 BELLINI study of Ven-Vd vs Vd showed inferior OS for Ven-Vd. This was mostly due to infection risk. So...

Answer from: Medical Oncologist at Academic Institution

Excellent question. Others (@Ben Derman and @Craig C. Hofmeister) had answered several of these subquestions in a prior thread here:https://www.themednet.org/question/10770.But we didn't fully address the ideal combo regimen to use in the appropriate setting - e.g., t(11;14) still present by FISH [B...

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