‘Myeloma Patients Living Longer’ – The Cure Panel Talk Show with Dr. Shaji K. Kumar and Dr. Edward A. Faber
We had a very informative and comprehensive panel with Dr. Kumar and Dr. Faber shooting out results of drugs used in combination as well as new drugs on the myeloma block. Barring a few technical glitches, (we lost Dr. Kumar for a few minutes); I think the panel did very good. We thank Dr. Kumar, Dr. Faber, Gary, Pat, Jack, Cynthia and all the participants.
Dr. Kumar began the panel discussion with a talk on multiple drugs that are being used as well as those that are on the anvil. He brought to notice a remarkable observation – myeloma patients diagnosed in the most recent 5 years are living a lot longer than those patients diagnosed over 10 years ago are.
This is a very exciting data. Thus, new drugs introduced into the field are making an impact and we are closer to making myeloma a chronic disease and hopefully curing some of the disease.
The developments in the drug scenario in multiple myeloma can be divided into two: new drugs that have come through clinical trials and different approaches that are being taken for using the existing drugs for treatments. Talking on new versions of existing drugs as well as combination of new novel drugs with existing drugs, Dr. Kumar talked about the following:
Carfilzomib, a relatively new drug, a proteasome inhibitor. Effective drug with low side effect profile (less neuropathy). Carfilzomib has shown promising results when used in combination with lenalidomide, dexamethasone as first time treatment as well as when used in combination with thalidomide and dexamethasone. Carfilzomib works in patients in whom bortezomib has stopped working. Carfilzomib in combination with cyclophosphamide significantly improves response.
Pomalidomide, awaiting approval by FDA is very well tolerated and side effects can be managed by dose reduction. When used in combination with dex it worked very well. Similar combinations of pomalidomide with cyclophosphamide and prednisone in patients with relapsed myeloma had 50% overall response rate. A combination of carfilzomib and pomalidomide is a safe combination with improved results.
MLN9708, the only oral proteasome inhibitor, is a version of Velcade, with fewer side effects and fairly safe. MLN9708, administered once a week have shown very promising results in its early studies. It has been proved to be effective in patients who have become refractory to Velcade.
Combination drugs are proving to help a lot of myeloma patients. Dr. Kumar went on to talk about bendamustine now being investigated in combination with revlimid, bendamustine and velcade in a large trial.
He also brought to focus the question on maintenance post transplant. According to European studies, patients have not been proved to live longer while on maintenance therapy, however myeloma comes back later while on maintenance. He also mentioned that trials for high risk myeloma patients would help in understanding and learning how to treat high risk group better.
Dr. Faber began his talk by making two points based on research results presented at ASH 2012 and 2011:
– Response rates in patients are becoming better
– Myeloma is being kept stable for longer periods
One of the reasons for these improved patient outcomes is the extensive research being conducted with new novel agents and second-generation drugs like Carfilzomib, Pomalidomide, MLN9708 which combine safely in a manner that patients are able to tolerate them for longer periods. Dr. Faber mentioned some of the interesting recent studies that caught his attention,
– Combination of lenalidomide and thalidomide conducted by MD Anderson
– 4 drug combination of bortezomib, melphalan, prednisone and thalidomide by Antonio Palumbo
Some of the promising and exciting new drug therapies that Dr. Faber mentioned included,
ARRY 520 a KSP protein inhibitor, Phase I study by Dr. Robert Orlowsky and group. The new drug exhibited single agent activity with durable responses. Very encouraging and durable responses.
BTK (Brutin tyrosine kinase) inhibitor, which is a tumor suppressor and hopefully would inhibit myeloma cell growth.
Dr. Faber talked about immunomodulatory agents used in myeloma treatment like elotuzumab, BAFF – protein inhibitor and activity of Daratumumab (targeting CD38 antibody). Daratumumab showed remarkable single agent activity in heavily treated myeloma patients proving monoclonal antibodies may not need helpers like a imids/corticosteroids. They even showed lesser side effects.
Monoclonal antibodies are well tolerated with less side effects. They may be the next agents that may help patients with multiple myeloma.
So in all, combination therapy and new drugs are doing wonders and getting promising results.
Will continue with the panelists and participant questions ….