June 4, 2013

MMRF Newsflash from ASCO 2013 - Volume 3

Welcome to our third and final report on the 2013 American Society of Clinical Oncology Annual meeting featuring the Multiple Myeloma poster session.

Key takeaways from posters reporting studies in newly diagnosed patients were:

  • The question of early versus delayed autologous stem cell transplant for patients receiving upfront therapy RVD - Revlimid (lenalidomide) in combination with Velcade (bortezomib) and dexamethasone (dex) - was addressed. Findings suggest that delayed transplant is feasible with similar rates of disease progression and survival.
  • Updated results of a phase I/II trial with the combination of Kyprolis (carfilzomib), Revlimid (lenalidomide)-dex demonstrated high response rates, including a high rate of minimal residual disease negative status among the patients achieving stringent CR (92%). Two year survival was 98%. This regimen was well tolerated and the most common side effects were low platelet counts and infection. A Phase III study assessing this combination in newly diagnosed patients is planned.

Updates on previously reported trials, new combinations and new agents for relapsed refractory patients were highlighted.

  • Analyses of the phase III trial with relapsed/refractory patients treated with Pomalyst (pomalidomide) and low-dose dex showed that patients with moderate kidney problems (renal impairment) and those with high-risk features achieved similar benefit to other patients in the study. Benefits were also similar regardless of age.
  • A phase I/II MMRC study of the combination of Kyprolis, Revlimid and dex in 84 patients showed high overall response rates (69-77%) including 36% very good partial responses (VGPR). Most impressive was the rapid time to response (1 month) and 22 month duration of response. Results of the Phase III study looking at this combination versus Revlimid-dex in relapsed/refractory myeloma are eagerly awaited.
  • An analysis of the PANOROMA-2 study which evaluated the HDAC inhibitor, panobinostat, in combination with Velcade and dexamethasone in Velcade-refractory patients was reported. The overall response rate was 34.5% and the time without disease progression (progression-free survival) was 5.4 months. The analysis looked at outcomes based on patients’ prior therapies. Progression-free survival was shorter in those who had previously progressed while still taking Velcade (4.2 months) compared with those who progressed after stopping Velcade (7.6 months). Additionally, patients whose last prior therapy included dex had worse outcomes.
  • Updated results for the phase I/II study with elotuzumab in combination with Revlimid-dex showed that this combination resulted in an overall response rate of 84% with 12% of patients achieving CR. The most common severe side effects were low white blood cell counts and low platelet counts. Phase III trials in both relapsed/refractory patients and new diagnosed patients are underway.