A Game of Chess: Finding the Right Treatment Options for Patients with Multiple Myeloma

In 2013, Mark Young received a diagnosis that would change the rest of his life. After experiencing severe back pain, an x-ray showed four broken vertebrae in the middle of his back, followed by an MRI that confirmed his multiple myeloma diagnosis.

Multiple myeloma is a cancer of plasma cells, which are types of white blood cells found in the bone marrow that grow uncontrollably and crowd the normal plasma cells in the bone marrow.¹ It is the second most common blood cancer in the world¹ – falling into the same category as leukemia and lymphoma.

In a call with Mark’s wife, the orthopedic surgeon said that his diagnosis likely meant he had six-months-to-a-year to live, and that he’d likely be spending the rest of his life in a wheelchair.

Determined, Mark sought to join a clinical trial, and has since received three lines of treatment. After a combination of three anti-myeloma drugs, including lenalidomide and a proteasome inhibitor, and a new therapy with four drugs and a different mechanism of action, Mark relapsed. Five years into his treatment and quickly into his second relapse, Mark attended a conference to learn more about the latest multiple myeloma research. There, he learned that his oncologist had secured his spot in a clinical trial. He began his third line of treatment with Sarclisa® (isatuximab-irfc), in the ICARIA-MM clinical trial. Since Mark’s participation in the trial, Sarclisa has been approved by the Food and Drug Administration for use in combination with pomalidomide and dexamethasone to treat adults with relapsed refractory multiple myeloma who have received at least two prior therapies, including lenalidomide and a proteasome inhibitor.²

A Game of Chess

Mark compares his diagnosis to a game of chess: “With treatment, it’s like move, counter move,” he said, adding that there are a variety of treatment options for patients with multiple myeloma to learn more about.”

Standard treatment options for multiple myeloma include³:

• Targeted therapies that focus on specific weaknesses present within cancer cells to cause them to die
• Immunotherapy, which uses a patient’s immune system to fight the cancer
• Chemotherapy, which kills fast-growing cells
• Corticosteroids that regulate the immune system to control inflammation
• Bone marrow transplant, or a stem cell transplant, to replace diseased bone marrow with healthy bone marrow
• Radiation therapy, to shrink myeloma cells in a specific area

Further, multiple myeloma treatments fall into various drug classes, including proteasome inhibitors, immunomodulatory drugs, nuclear export inhibitors, alkylating agents, corticosteroids, histone deacetylase inhibitors, bisphosphonates and monoclonal antibodies.⁴

Despite growing treatment options, many patients with multiple myeloma will relapse or become refractory to treatment. Relapsed multiple myeloma is when the cancer returns after treatment or a period of remission, while refractory multiple myeloma refers to when the cancer does not respond or no longer responds to therapy.⁵

Because there are a variety of treatment options and currently no cure for multiple myeloma, it is important for patients to be knowledgeable about their options.

As explained by Dr. Joshua Richter, assistant professor of medicine, hematology and medical oncology at Mount Sinai: “It's really important to know your treatment options because there are literally so many options now. It's kind of like a game of chess, where you look at the game board initially, and the options are infinite and as the game of chess progresses, the number of options gets more and more limited. It’s the same thing with myeloma. So, it's really the reason why it's so crucial to get all this information, because you can make certain maneuvers early on that may affect your options later. So it's really about keeping the landscape and the options as broad as possible, so that we can adjust when necessary.”

At Mount Sinai, they use what Dr. Richter calls the multi-omic approach – proteomics, genomics and immunology. “[We use this] to really figure out what drives an individual's myeloma forward. So, instead of just saying this drug is good and that drug is good, we can get patient-level detail.”

Choosing the Right Treatment

Mark’s biggest piece of advice for patients is to seek more information on the disease and find a care team that specializes in myeloma. “Everybody's different. Everybody's treatment is different. Everybody's response to their treatment is different. It's all very individualized,” Mark said. “Do your homework and find out who's the global guru for your particular type of cancer.”

The landscape of multiple myeloma is consistently changing, with novel agents and combination regimens under evaluation in clinical trials. When deciding between treatment options, Dr. Richter added, side effects play an important role in that decision.

“Our ability to address [side effects] now is far better than it used to be,” he explained. “And this really allows us to keep you intact. And I always talk about the three things a relapsed myeloma patient is worried about being attacked: their nerves, counts and kidneys. We have a sense for what's in the near future for treatment, but what about the far future? I don't want to find out a decade from now that we have the ‘magic bullet,’ that we can cure everyone, but we can't give it to certain people because their counts are too low or their nerves are too bad. So, it's really about keeping them intact, not just for the next thing, but for the long term.”

While side effects play a crucial role in treatment decisions, and even with quality of life while living with multiple myeloma, it is also key for patients to have an open line of communication with their health care providers. “A big thing is to be honest with your entire care team. We want to know how you feel, even if it's something small, because something small to a patient may be something really huge. For example, if a patient has a little tingling in their feet but they don't want to mention it because it's not really bothersome. But by the time it becomes bothersome and they mention it, it may not be reversible,” Dr. Richter said.

Moving Forward

With the hope that multiple myeloma can become a manageable, treatable condition for patients, Mark has one piece of advice for others: “Take everything one day at a time, one appointment at a time,” he said. “Don't get too far ahead of yourself. When I first met with [my doctor], he said to treat every day like it's a Saturday. Try to enjoy every day. Be much more relaxed and mindful.”

With such promise in the treatment landscape for multiple myeloma patients have a lot to look forward to. Dr. Richter said, “We may have the tools in front of us that, if we knew exactly how to use the tools at our disposal today for the right individual, we may be able to effectively treat more and more people. It's all about the next generation of therapies, which are around the corner.”

To learn more about a treatment option for relapsed refractory multiple myeloma, please visit mymyelomaoptions.com.

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IMPORTANT SAFETY INFORMATION AND INDICATION FOR U.S. PATIENTS

What is SARCLISA?

SARCLISA is a prescription medicine used in combination with pomalidomide and dexamethasone to treat adults who have received at least 2 prior therapies, including lenalidomide and a proteasome inhibitor, to treat multiple myeloma.

It is not known if SARCLISA is safe and effective in children.

Important Safety Information

Do not receive SARCLISA if you have a history of severe allergic reaction to isatuximab-irfc or any of the ingredients in SARCLISA (see the list of ingredients in full Prescribing Information).

Before receiving SARCLISA, tell your healthcare provider about all of your medical conditions, including if you:

• are pregnant or plan to become pregnant. SARCLISA may harm your unborn baby. You should not receive SARCLISA during pregnancy.
  • Females who are able to become pregnant should use an effective method of birth control during treatment and for 5 months after their last dose of SARCLISA. Talk to your healthcare provider about birth control methods that you can use during this time.

Tell your healthcare provider right away if you think you are pregnant or become pregnant during treatment with SARCLISA.

• are breastfeeding or plan to breastfeed. It is not known if SARCLISA passes into your breast milk. You should not breastfeed during treatment with SARCLISA.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

How will I receive SARCLISA?

• SARCLISA will be given to you by your healthcare provider by intravenous (IV) infusion into your vein.
• SARCLISA is given in treatment cycles of 28 days (4 weeks), together with the medicines pomalidomide and dexamethasone.
  • In cycle 1, SARCLISA is usually given weekly.
  • Starting in cycle 2, SARCLISA is usually given every 2 weeks.

Your healthcare provider will decide how long you should receive SARCLISA.

• If you miss any appointments, call your healthcare provider as soon as possible to reschedule your appointment.
• Your healthcare provider will give you medicines before each dose of SARCLISA to help reduce the risk of infusion reactions (make them less frequent and severe).

What are the possible side effects of SARCLISA?

SARCLISA may cause serious side effects, including:

• Infusion reactions. Infusion reactions are common with SARCLISA and can sometimes be severe.
  • Your healthcare provider will prescribe medicines before each infusion of SARCLISA to help decrease your risk for infusion reactions or to help make any infusion reaction less severe. You will be monitored for infusion reactions during each dose of SARCLISA.
  • Your healthcare provider may slow down or stop your infusion, or completely stop treatment with SARCLISA, if you have an infusion reaction.

Tell your healthcare provider right away if you develop any of the following symptoms of infusion reaction during or within 24 hours after an infusion of SARCLISA:

• feeling short of breat
• cough
• chill
• nausea

• Decreased white blood cell counts. Decreased white blood cell counts are common with SARCLISA and certain white blood cells can be severely decreased. You may have an increased risk of getting certain infections, such as upper and lower respiratory infections.

Your healthcare provider will check your blood cell counts during treatment with SARCLISA. Your healthcare provider may prescribe an antibiotic or antiviral medicine to help prevent infection, or a medicine to help increase your white blood cell counts during treatment with SARCLISA.

Tell your healthcare provider right away if you develop any fever or symptoms of infection during treatment with SARCLISA.

• Risk of new cancers. New cancers have happened in people during treatment with SARCLISA. Your healthcare provider will monitor you for new cancers during treatment with SARCLISA.
• Change in blood tests. SARCLISA can affect the results of blood tests to match your blood type. Your healthcare provider will do blood tests to match your blood type before you start treatment with SARCLISA. Tell all of your healthcare providers that you are being treated with SARCLISA before receiving blood transfusions.

The most common side effects of SARCLISA include:

• lung infection (pneumonia)
• decreased red blood cell counts (anemia)
• upper respiratory tract infection
• decreased platelet counts (thrombocytopenia)
• diarrhea

These are not all the possible side effects of SARCLISA. For more information, ask your healthcare provider or pharmacist.

Please see full Prescribing Information, including Patient Information.

Click here to learn more about Sanofi's commitment to fighting counterfeit drugs.

1. International Myeloma Foundation. What is Multiple Myeloma? Available at: https://www.myeloma.org/what-is-multiple-myeloma. Accessed November 2020.
2. SARCLISA (isatuximab-irfc) Full Prescribing Information.sanofi-aventis. LLC. Bridgewater, NJ.
3. The Mayo Clinic. Multiple Myeloma – Diagnosis & Treatment. Available at https://www.mayoclinic.org/diseases-conditions/multiple-myeloma/diagnosis-treatment/drc-20353383. Accessed November 2020.
4. American Cancer Society. Drug Therapy for Multiple Myeloma. Available at https://www.cancer.org/cancer/multiple-myeloma/treating/chemotherapy.html. Accessed November 2020.Multiple Myeloma Research Foundation. Multiple Myeloma Prognosis - Multiple Myeloma Survival Rate. Available at: https://themmrf.org/multiple-myeloma/prognosis. Accessed November 2020.