June 2, 2013

MMRF Newsflash from ASCO 2013 - Volume 1

Multiple Myeloma Education Session


Welcome to our first day of on-site coverage of the 2013 American Society of Clinical Oncology (ASCO) Annual meeting.

Today, a Multiple Myeloma Education session focused on advances in diagnostics and management. The session featured Drs. Donna Reece from the Princess Margaret Hospital in Toronto, Robert Orlowski from MD Anderson Cancer Center in Houston, and Jesus San-Miguel from the Hospital Universitario de Salamanca in Spain.

Dr. Reece focused on initial therapy, highlighting advances with the integration of newer therapies, for both patients eligible for transplant and those ineligible for transplantation. The integration of newer agents, ie, Velcade and Revlimid, before and after autologous stem cell transplantation has extended time without disease progression (progression-free survival) from 2 years to approximately 3 years.

  • Newer regimens being explored for patients eligible for stem cell transplantation include Kyprolis (carfilzomib), Pomalyst (pomalidomide), and ixazomib, an oral proteasome inhibitor (in the same class of drugs as Velcade and Kyprolis) that is being evaluated in Phase III clinical trials
  • Progress in treatment of elderly, non-transplant patients, has been made with the addition of newer agents (i.e. Revlimid, Velcade, Thalomid) to melphalanprednisone (MP), but these regimens come with significant side effects. Revlimd-dex is a commonly used regimen which is better tolerated

Dr. Orlowski focused on new approaches to treatment of patients who are refractory to both Velcade and Revlimid (aka “double-refractory patients”).

  • The introduction of both Kyprolis and Pomalyst has improved outcomes in these patients, but further advances are still needed given that typically 20-30% of patients respond to either of these treatments and for a duration of approximately 9-12 months. To this end, new combinations including these drugs are being studied
  • New novel drugs in development for double-refractory patients appear promising and include ARRY-520 and daratumumab

Dr. San-Miguel reviewed current and emerging techniques for diagnosis and monitoring.

  • Emerging tests, specifically the Hevylite assay and flow cytometry immunophenotyping, may be able to help predict the risk of progression from MGUS and smoldering myeloma to symptomatic disease
  • Measuring minimal residual disease (MRD) is a growing area of interest as the presence (or absence) of MRD appears to be a strong indicator, even independent of response, of a patient’s prognosis. Many countries in Europe are collaborating to develop standards for evaluating MRD, and those discussions are extending to the US as well
  • Additionally, flow cytometry immunophenotyping may have a role in monitoring, particularly during maintenance therapy

Following the Education Session, the MMRF recorded a webcast with these doctors to discuss these topics in more detail as well as review data being presented at the meeting. The webcast will be available beginning Tuesday. In the meantime, check back here for ongoing updates.