We were delighted to have our 20th episode of Cure Panel Talk Show with Dr. Shaji Kumar of Mayo Clinic on “Myeloma Updates from ASCO 2013″, on July 25, 2013 @ 6pm ET. The show was hosted by Priya Menon (Scientific Media Editor at Cure Talk). Myeloma survivor and blogger Gary Petersen was our co-host for the show. On the panel we had myeloma survivor and volunteer Jack Aiello, myeloma survivor/blogger/author Pat Killingsworth and myeloma survivor/blogger Nick Van Dyk.
This is a brief summary of the panel discussion -
What according to Dr. Shaji Kumar, were the 3 key findings at ASCO?
Following are the 3 key findings at ASCO, according to Dr. Kumar:
- Concept of looking for Minimal Residual Disease (MRD) is becoming a part of most new studies. The way MRD testing is done has changed from older techniques like microscopic view of residual plasma cells in patient samples, which offers low resolution, whereas new ones like flow cytometry to find residual plasma cells from patient samples, PCR and deep sequencing of patient samples for detection of extremely low levels of myeloma cells. Thus, with newer techniques offering high resolution data, MRD testing has become very powerful and as we increase our ability to detect small amounts of residual tumor after therapy, we can identify patients who’d perform better, and to see if giving more treatment to patients who have tumor left behind would have any long term benefit.
- There was another long observational study of patients with monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma which was able to show that previously recognized markers like M protein and presence of plasma cells in bone marrow, predict the risk of progression to myeloma that need therapy. One could identify patients at very high risk of multiple myeloma from gene expression profiles, thus making early intervention a possibility.
- One very interesting study showed daratumumab, a monoclonal antibody (mAb) targeting CD38 (a protein on surface of myeloma cells). The results indicated that the mAb is very well tolerated, and in over third of the total patients, multiple myeloma had gone down with this mAb. There’s a lot of hope that daratumumab would get to clinic in near future.
These, Dr. Kumar said are steps of what hopefully would be a cure for myeloma.
Talking about new agents being tested for myeloma discussed at ASCO, Dr. Kumar said that there are exciting new versions of existing classes of drugs and there are other drugs with new mechanisms and newer and probably better targets for multiple myeloma. There are also new mAbs specifically targeting myeloma cells. Some examples he gave are-
- Elotuzumab, a monoclonal antibody targeting CS1, a cell surface glycoprotein highly expressed on myeloma cells- in relapsed/refractory multiple myeloma, phase III study completed.
- MLN9708, an oral proteasome inhibitor (PI)- in relapsed/refractory multiple myeloma, phase I study completed, and phase III study to begin soon at Mayo Clinic.
- Histone deacetylase (HDAC) inhibitors- studies with two drugs, but more and larger studies’ results are awaited.
- Exciting new drug combinations combining old and new drugs for better control of disease
Asked about agents with immediate applications in treating multiple myeloma, here’s what Dr. Kumar had to tell us-
- Pomalyst and carfilzomib- 2 new drugs which are also FDA approved and available in clinics, have immediate implications in treating myeloma patients specially in combination with other drugs.
- Daratumumab, elotuzumab and MLN9708- most advanced in clinical trials and not yet approved by the FDA, are also very close to the clinic.
Q- Is MRD currently used by Mayo Clinic to measure success of treatment?
Dr. Kumar- Yes it is and we use flow cytometry of bone marrow samples to get a sense who’s going to deep response versus who is not. However what we really need is the data showing that if we do something different to people who did not get MRD negative state, its going to change outcome for those patients.
Q- We hear now about Immune therapy, and new drugs like Daratumumab, and Elotuzumab. How do you see this fitting in to the treatment of myeloma. Do you see a combination like Daratumumab, Velcade, Revlimid, and Dexamethasone going to a Phase III trial.
Dr. Kumar- The beauty of these mAbs is efficacious on their own, and have no side effects overlapping with existing drugs. So they can be combined, without changing toxicity but improving efficacy.
Q- Insights to Mayo clinic research in multiple myeloma?
Dr. Kumar- We have a multifaceted research program looking at the disease spectrum. There’s a lot of research going into find why lot of patients with monoclonal gammopathy go on to develop multiple myeloma. With respect to treatment of multiple myeloma, we have a lot of new drugs like pomalidomide and MLN9708. There’s also a study in which there’s a virus that is trained/reprogrammed to target and destroy myeloma cells and this is in clinical trials.
Q- I know that maintenance treatment has shown significant improvement in progression-free survival (4 yrs vs 2 yrs) but now have heard that there are overall survival benefits. Can you provide specific overall survival comparisons?
Dr. Kumar- Maintenance therapy is there for a long time and initially was used to increase progression free survival after stem cell transplant. It’s currently used even without stem cell transplant and just after completing regular therapy in order to improve progression free survival. There are still some doubts regarding overall survival benefits of maintenance therapy owing to lack of enough studies.
Q- With the announcement of the IMF’s Black Swan initiative, and the increasing use of MRD testing, is this tantamount to a recognition that some patients are being cured with current therapies?
Dr. Kumar- Overall, in CR patients, MRD tests show 20-40 % patients as MRD negative, and they live much longer. Type of treatment and aspect of disease biology of each person, important determinants whether MRD negativity might mean something.
In summary, I felt that we had an amazing discussion on the latest innovations and drug discoveries for multiple myeloma. Dr. Kumar provided us very useful updates from ASCO 2013 and also with his personal views on multiple myeloma where he touched up on the concept of personalized medicine when he talked about different aspects of disease biology.
We thank Dr. Shaji Kumar for sharing ASCO 2013 updates and for having an informative and useful discussion with all our participants. We also thank our host Priya Menon, our co-host Gary Petersen, and our panelists Jack Aiello, Pat Killingsworth and Nick Van Dyk for being with us on this platform. Wish you all a happy life!
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