Optimizing therapy in bortezomib-exposed patients with multiple myeloma.

Multiple myeloma prognosis has improved significantly during the past decade, with survival prolongation mainly due to the incorporation of novel agents. Bortezomib represents one of the main backbone agents of antimyeloma treatment. Areas covered: This review aims to identify possible and available therapeutic options for patients who experience disease refractoriness following bortezomib exposure. Expert commentary: For patients who finally relapse after bortezomib exposure treatment strategy should be individualized. For patients with disease resistant to bortezomib, the combination of lenalidomide-dexamethasone with a monoclonal antibody seems to be the most optimal choice for second-line treatment. For third line, pomalidomide-based regimens can be effective even in bortezomib refractory patients. Several novel agents are currently under investigation in order to treat multi-refractory disease.G.