Abstract
Multiple myeloma (MM) is a very heterogeneous disease. In patients with MM, the most common variations observed include alterations of MAPK pathways with NRAS, KRAS or BRAF mutations.
In patients with the presence of BRAF kinase activation mutation or mutations in RAS, a benefit of treatment with BRAF inhibitor (vemurafenib) or MEK inhibitor (trametinib) has been already shown. In some patients, treatment with an inhibitor of Bcl-2, venetoclax, can be also effective.
Inhibition of the molecule MCL-1 or MYC pathway can be also considered. Without a doubt, the biggest benefit in improvement of prognosis of MM patients who are refractory to proteasome inhibitors (PI) and immunomodulatory drugs (IMID), we can nowadays find in monoclonal antibodies (MoAb).
Data from recent trials support the use of elotuzumab and daratumumab, in particular. The efficacy of the other MoAb is currently the subject of intensive research.
A sophisticated treatment method may be the use of a modified T-lymphocytes expressing synthetic chimeric antigen receptors (CAR T-cell therapy).