Dupilumab in Multiple Myeloma: A Case Series

Clinical Practice Points

• •Lenalidomide and other immunomodulatory drugs (IMiDs), routinely used for the treatment of multiple myeloma (MM), are frequently associated with skin toxicities that appear to be T helper 2 (Th2)-mediated.
• •Dupilumab, a human monoclonal antibody FDA-approved for the treatment of Th2-driven atopic conditions, has shown clinical utility in treating lenalidomide-associated skin toxicities. Dupilumab targets the IL-4 receptor alpha chain (IL-4Rα), thereby inhibiting IL-4 and IL-13 signaling, with resultant blockade of Th2 inflammation specifically as opposed to broad immunosuppression.
• •Increased activity of IL-4 and IL-13 has been closely associated with malignancy due to the roles of these cytokines in carcinogenesis and modulation of tumor immunosurveillance. Dupilumab, by blocking both of these cytokines, may potentially be tumor-protective in MM patients.
• •In this case series of three MM patients treated with dupilumab for lenalidomide rashes, remitted MM in one patient remained stable for 19 months while on dupilumab alone and, shortly after discontinuing this agent, rapid disease progression was observed. A second patient remained in remission with dupilumab treatment for 15 months, the latter 12 of which were without concurrent maintenance therapy. A third patient was initiated on dupilumab while receiving induction therapy for MM and, with both treatments simultaneously, achieved normalization of MM blood markers.
• •Dupilumab is an effective therapy for IMiD-mediated eczematous rashes; furthermore, it may have therapeutic benefits as adjuvant therapy for MM. If confirmed, its use stands to provide a significant benefit for these patients' quality of life and overall prognosis.