A num­ber of new drugs are on the horizon for re­lapsed and re­frac­tory patients, as discussed by physicians at the 2009 Inter­na­tional Myeloma Workshop (IMW). The dis­cus­sion covered drugs in all stages of devel­op­ment, from those still undergoing initial lab testing to ones already in inter­na­tional clin­i­cal trials.

Overall re­spon­siveness to treat­ment has im­proved dramatically with the recent in­tro­duc­tion of more potent agents such as Revlimid (lena­lido­mide) and Velcade (bor­tez­o­mib). Doctors are now testing com­bi­na­tions of these two drugs with newer pharma­ceu­ticals. Of the two, Velcade has been …

A recent paper published in Lancet Oncology examines drugs that target biological mechanisms in multiple myeloma. This article is the second of three articles discussing new drugs for myeloma treatment.

Researchers have begun to understand the multi-step process by which myeloma occurs. Key features of this process are signaling pathways, which take information from outside of the cell and from within the cell to create a cascading reaction. While signaling pathways are a part of all cells, they are problematic if not regulated.

Studies have shown that a pathway involving the NFkB …

A new drug called perifosine, when given in combination with other drugs, has been shown to be effective against relapsed or refractory multiple myeloma. Several perifosine studies were presented at the American Society for Hematology (ASH) meeting this year.

Perifosine prevents the growth of myeloma cells by inhibiting the pathway of Akt, a key signaling protein that regulates cellular survival. Perifosine also promotes apoptosis, or programmed cell death, by activating a specific protein pathway called the JNK pathway.

Perifosine first demonstrated clinical activity when combined with another drug, dexamethasone. …