Multiple Myeloma Drug Therapy: Considerations on Effectiveness and Safety

Multiple myeloma (MM) is an incurable hematological cancer that affects mainly older adults. Patients are exposed to the use of multiple drugs to treat other comorbidities in addition to MM, increasing the burden of antineoplastic treatment. Thus, the objective of this chapter is to present (i) the main drug classes and single drugs approved for the MM treatment; (ii) relevant issues related to the effectiveness and safety of MM therapy and quality of life; and (iii) the use of multiple drugs by MM patients in an aging context. MM therapy has evolved with the introduction of immunomodulatory drugs, proteasome inhibitors, histone deacetylase inhibitors, and nuclear export inhibitors and immunotherapy (monoclonal antibodies, antibody-drug conjugate, and CAR T cell therapy). The development of drugs for the treatment of relapsed/refractory MM is still a challenge. Supportive therapy of MM usually characterizes polypharmacy and exposes patients to potentially inappropriate medication, fall risk–increasing drugs, drugs that induce osteoporosis or fracture and drugs with anticholinergic activity. MM therapy has markedly increased the survival of MM patients. Supportive medications can be harmful for older adults with MM and should be reviewed considering their frailty level. Valuable tools can help to evaluate medication burden, adherence, adverse events, and health-related quality of life (HRQoL) in research and clinical practice.