Predictors of exposure, therapeutic and adverse effects of medicines used in the treatment of multiple myeloma

Multiple myloma (MM) is a cancer of plasma cells and is on the rise worldwide, particularly in the US, Australia, and Western Europe. Nearly 2% of cancer diagnoses and more than 2% of cancer deaths in the US are due to MM. Since 1990, the global incidence of MM has increased by 126% and US incidence by over 40%, whilst global mortality has increased by 94% [1].
There are many important medicines used in the treatment of multiple myeloma (MM) including ixazomib, daratumumab, and isatuximab. Ixazomib is a proteasome inhibitor which is a drug that inhibit the cellular protein called ‘proteosome’ leading to potein build up and killing of myeloma cells. Daratumumab and isatuximab are monoclonal antibodies are medicines created in the lab and act in a simular fashion to the body’s own antibodies where they help the immune system to recognize and block a specific target. However, response and toxicity to these drugs are highly variable and there are no accurate and reliable tools to date to accurately predict patients who will benefit most. Using the diverse range of data collected from MM clinical trials, including individual’s demographic, clinical, laboratory, disease and genetic characteristics, it is possible to identify predictors and develop clinical tools that enable improved prediction of therapeutic and adverse outcomes from MM medicines. Being able to identify the expected response and adverse effect profile may enable patients and clinicians to make better decisions regarding whether to commence, continue, or change dosing of medicines used in the treatment of MM.