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Treatment strategies that com­bine Revlimid with newer types of anti-tumor agents may be ef­fec­tive for re­lapsed and re­frac­tory mul­ti­ple myeloma, ac­cord­ing to myeloma experts who reviewed re­­sults from stud­ies of these new com­bi­na­tions.

Refractory and re­lapsed mul­ti­ple myeloma is notoriously dif­fi­cult to treat. For every remission period that is achieved, relapse typ­i­cally arises sooner and with greater re­sis­tance to pre­vi­ously used ther­a­pies. These patients have lim­ited op­tions for ther­apy.

In examining trials that tested new ther­a­pies in com­bi­na­tion with Revlimid (lena­lido­mide), the authors of the review hoped to find the po­ten­tial …

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Viracept Demonstrates Anti-Myeloma Activity – Results of a recent preclinical trial show that Viracept (nelfinavir), alone or in combination with other common myeloma drugs, prevents myeloma cell growth and causes cell death. Viracept is a protease inhibitor and is approved in the United States and Canada for the treatment of HIV.  Studies have suggested that protease inhibitors such as Viracept may be effective against cancer.  It is thought that they may work similarly to proteasome inhibitors like Velcade (bortezomib), In this preclinical study, Viracept enhanced the anti-cancer activity of myeloma drugs Velcade and dexamethasone (Decadron) as well as the epilepsy drug -- and potential anti-cancer agent -- valproic acid (Depakote, Depakene).  Viracept also slowed tumor growth in mice with myeloma. For more information, see the study in Haematologica (pdf).

Study Helps Demonstrate How Green Tea Fights Myeloma – EGCG, an active compound in green tea, has previously been shown to have cancer preventative and cancer fighting properties.  However, little was known about the way EGCG works to fight cancer.  In this recent preclinical study, Japanese researchers showed that EGCG works by disrupting the outer membrane of myeloma cells, but not healthy cells, thereby selectively killing myeloma cells. For more information, please see the study in Biochemical Journal (pdf).  For information about green tea blocking the effectiveness of Velcade, see related Beacon news.

ACY-1215 In Combination With Velcade Shows Potential As Myeloma Treatment – The results of a recent preclinical study show that low doses of ACY-1215 in combination with Velcade kill multiple myeloma cells. ACY-1215, which is being developed by Acetylon Pharmaceuticals, belongs to a class of drugs called HDAC inhibitors. Zolinza (vorinostat) and panobinostat are also HDAC inhibitors that are being studied for the treatment of myeloma. The study showed that ACY-1215 in combination with Velcade slowed tumor growth and extended the overall survival of mice with myeloma. ACY-1215 is currently being studied in a Phase 1/2 clinical trial in combination with Velcade and dexamethasone in patients with relapsed/refractory multiple myeloma. For more information or to enroll in the trial, please see the study in Blood (abstract) and the clinical trial description.

NVP-HSP990 May Be Active Against Myeloma – Results of a recent preclinical study show that NVP-HSP990, alone or in combination with other myeloma treatments, may be effective at treating multiple myeloma. NVP-HSP990, which is being developed by Novartis (NYSE: NVS), is a heat shock protein 90 inhibitor like tanespimycin, which was in Phase 3 trials for myeloma when its development was halted in 2010.  The recent study showed that NVP-HSP990 killed myeloma cells in the laboratory, and this activity was significantly enhanced in combination with melphalan (Alkeran).  For more information, see the study in Anticancer Research (abstract).