Oncology Frontier: Can you outline the recent changes that have occurred in the NCCN Guidelines as they relate to the treatment of myeloma?

　　《肿瘤瞭望》：请介绍NCCN多发骨髓瘤指南最近更新？

　　Dr Anderson: The latest update of the NCCN Guidelines is probably the most exciting yet. In terms of the initial management of the myeloma patient with newly diagnosed disease， there are more options than ever before. The most recent addition is lenalidomide and dexamethasone given continuously until the time of relapse. This is based on a randomized trial， the FIRST trial， where lenalidomide and dexamethasone given continuously extended the overall and progression free survival of non-transplant candidates. This is very exciting and further supports using novel drugs like immunomodulatory drugs together， not only as induction but also as a continuous and maintenance strategy.

　　In terms of the latest iteration for relapsed disease， the new guidelines now include for the first time， panobinostat and dexamethasone with bortezomib. Panobinostat is a histone deacetylase inhibitor and a new class of agent for treating relapsed myeloma. It will be the first of a whole new generation of this class of agents which currently allows us to use panobinostat with bortezomib， but someday more selective histone deacetylase inhibitors will be used， not only with protease inhibitors， but probably with immunomodulatory drugs as well.

　　So the most important thing about the NCCN Guidelines is that they have established algorithms or opportunities for treatment options for patients at different stages of the disease. More and more around the world， there is guaranteed access of patients to these novel agents. There is much progress that we can be very excited about， but it is important that patients can very quickly and in real time get access to these medicines so they can appreciate the benefits so they and their families can live longer， healthy and happy lives.

　　Anderson博士：NCCN指南的最新更新激动人心，在新诊断多发性骨髓瘤患者的初期管理方面有了更多选择，即“来那度胺联合地塞米松持续给药直至复发”。这项推荐是基于FIRST随机试验结果，

　　FIRST试验评估了持续来那度胺疗法联合地塞米松直至疾病进展对比美法仑、强的松和沙利度胺（MPT）治疗18个月的疗效。FIRST试验是随机、非盲、三臂试验。研究结果显示，持续来那度胺疗法联合地塞米松治疗增加了PFS和OS获益。这项推荐为医生和患者提供了一种新的口服免疫调节剂治疗选项（不仅作为诱导药物而且作为持续和维持治疗药物）。

　　在复发性骨髓瘤指南推荐更新方面，第一次纳入了“帕比司他+硼替佐米+地塞米松”的联合方案。帕比司他是获批治疗多发性骨髓瘤的首款HDAC抑制剂，是一种广谱的HDAC抑制剂；复发性骨髓瘤治疗有时也用选择性HDAC抑制剂治疗；HDAC抑制剂可与蛋白酶抑制剂联用、也可与免疫调节药物联用。

　　最重要的是NCCN指南为不同阶段的患者提供了治疗选择，在世界各地，这些推荐药物的获取越来越方面。我们对这些进展感到高兴，并希望患者能够很及时地获取药物，获益于NCCN指南推荐。