The treatment of multiple myeloma depends on several factors: stage of the disease, Age of the patient, general condition and genetic factors. It is based on a combined approach including targeted treatments, chemotherapy, immunotherapy, and sometimes stem cell transplantation.

1. First-line treatment (newly diagnosed patient)

The initial treatment is aimed at reduce tumor burden and control symptoms.

a) Patients eligible for stem cell transplantation

For patients young people (< 70 years old) and healthy.

1. Induction treatment (reduction of the tumor before the transplant)
   • Standard triple therapy :
     • Proteasome inhibitor (ex: bortezomib).
     • Immunomodulatory (ex: lenalidomide or thalidomide).
     • Corticoid (ex: dexamethasone).
2. Autologous stem cell transplant
   
   • After chemotherapy at high doses (melphalan).
   • Enables prolonged remission.
3. Consolidation and maintenance treatment
   
   • Lenalidomide to maintain the response and delay relapses.

b) Patients not eligible for transplantation

For the older patients (> 70 years) or with comorbidities.

• Adapted triple therapy (bortezomib + lenalidomide + dexamethasone) or adapted chemotherapy.
• Maintenance treatment to prolong remission.

2. Treatment of relapses or refractory myeloma

When the disease recurs after initial treatment.

1. New targeted therapies
   
   • Ex: Daratumumab (anti-CD38 monoclonal antibody).
   • E.g.: Carfilzomib (proteasome inhibitor).
   • E.g.: Pomalidomide (immunomodulatory).
2. Catch-up chemotherapies
   
   • Association of new drugs to control relapse.

CAR-T cells and bispecific antibodies (new experimental approaches).

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Multiple myeloma is a hematologic cancer that affects plasma cells, a type of white blood cell found in the bone marrow. These cells, normally involved in the production of antibodies, proliferate uncontrollably in myeloma, thus affecting the production of normal blood cells and weakening bones.

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Differences between myeloma and other blood cancers

Multiple myeloma is often compared to leukemias and lymphomas, but it has distinct characteristics :

• It touches plasma cells in the bone marrow (not white blood cells like leukemia).
• It does not form a single tumor but Spreads into several bones.
• Unlike lymphomas, it does not directly affect the lymph nodes.

A biomarker, also called in some cases genetic mutations, is a measurable biological characteristic that is linked to a normal or non-normal process. In oncology, among biomarkers, certain abnormalities (often mutations) at the level of a gene can predict the action of a targeted drug. This information can be found in the molecular biology report (or NGS) or a consultation report. For ENT cancers, the most common biomarkers are the p16 protein, the epidermal growth factor receptor (EGFR), the HPV virus (human papilloma virus) and the TP53 gene.

ENT cancers, more commonly known as head and neck cancers, are cancers that develop in one of the organs of the upper aerodigestive tract (VADS, i.e. located in the digestive and upper respiratory systems). They therefore include cancers of the mouth (including lips and tongue), nasopharynx (cavum), hypopharynx, salivary glands, and larynx (more commonly referred to as throat cancer).

If ovarian cancer recurs within 6 months following initial chemotherapy treatment with Taxol and Carboplatin, it is called a “platinum-resistant” recurrence. This means that treatment with platinum salts has not been effective, and a change in medication will be required to treat the relapse.

If the recurrence occurs after 6 months (or 12 months) after stopping standard treatment, there is a high probability that the treatment will require a combination of chemotherapy agents with platinum salts, as the recurrence is likely to be “platinum sensitive.”

Among the main chemotherapy drugs used to treat this type of cancer, there are mainly associations between a platinum salt And a Taxane. For example, Carboplatin with Paclitaxel (Taxol), which can be administered every three weeks or weekly according to the protocol in place.

Lynch syndrome : This hereditary cancer predisposition syndrome is caused by mutations in DNA repair genes, such as MLH1, MSH2, MSH6, and PMS2. Women with Lynch syndrome have an increased risk of developing endometrial cancer.

Mutation PIK3CA : This mutation is frequently observed in endometrial cancer. PIK3CA mutations activate the PI3K/Akt/mTOR signaling pathway, which promotes the growth and survival of cancer cells.

Amplification ofHER2 : It has been observed in certain subtypes of endometrial cancer. This genetic alteration can lead to excessive activation of the HER2 signaling pathway, promoting tumor growth.

Knowledge of these mutations can guide the choice of treatments followed and clinical trials in which to participate.

This cancer forms in the tissue of the cervix, the lower, narrow part of the uterus. It is usually caused by a persistent infection by certain types of human papillomavirus (HPV), a sexually transmitted infection.

Chemotherapy is a treatment that uses powerful drugs to destroy cancer cells by stopping them from multiplying or spreading in the body. Chemotherapy medications can be given intravenously (into a vein), orally (as tablets or capsules), or by subcutaneous injection (under the skin).

Chemotherapy may be used alone or in combination with other treatments such as surgery or radiation therapy, depending on the type and stage of the cancer, as well as the patient's overall health. While chemotherapy can be very effective in destroying cancer cells, it can also damage healthy cells, leading to side effects such as hair loss, fatigue, nausea and vomiting, and suppression of the immune system.

In the context of lung cancer, chemotherapy drugs that are often used are:

- Cisplatin

- Carboplatin

- Pemetrexed

- Gemcitabine

- Docetaxel.

- Etoposide

- Paclitaxel (Taxol)

(Full list on the Klineo platform)

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The TNM score is a classification system used to assess the stage of a cancer, plan treatment, and predict prognosis.

Three parameters must be taken into account:

• The T describes the size and extent of the primary tumor
• The N indicates whether the cancer faces a regional lymph node extension
• The M indicates whether the cancer has spread to other parts of the body, called metastases

This information can be found on the pathologic report or a consultation report.

NB: On the platform, it is a simplified version of the TNM stadium. In the search fields, only the first number following the letter must be selected (ex: “Pt1c N0i+ M0” = “T1N0M0”)

The stage of lung cancer is determined by the TNM system and helps guide treatment. The stages vary from I (cancer that is limited to the lung) to IV (cancer that has spread to other parts of the body).