December 8, 2012

MMRF Newsflash from ASH 2012 - Volume 1


Welcome to our first day of on-site coverage of the 2012 American Society of Hematology (ASH) Annual meeting.

Highlights from today included a Multiple Myeloma Education session and a poster session focusing primarily on new agents.

Key takeaways from the Education Session which featured Drs. Gareth Morgan from Royal Marsden in London, Antonio Palumbo from the University of Torino in Italy and Vincent Rajkumar at Mayo Clinic-Rochester were:

  • For the majority of patients, and especially those with any risk factors like deletion 17(p) or t(4;14) should receive triple therapy, eg, Revlimid-Velcade-dexamethasone (RVD) or VCD (Velcade-cyclophosphamide-dex) as first-line therapy (the minority being some elderly patients and those with low risk disease)

  • High-dose chemotherapy followed by autologous stem transplant early in the course of disease appears to still offer patients the greatest benefit in terms of length of remission

  • Maintenance therapy appears to be beneficial for most patients, particularly those with lower risk disease, where the benefits of progression free survival and perhaps overall survival outweigh the risk of secondary cancers

  • There is still a great need to identify those patients at highest risk for relapse and determine the treatment regimen that could prolong remission time

There were several key posters presented:

  • Dr. Paul Richardson presented a poster on the phase II part of the PANORAMA 2 study assessing the histone deacetylase (HDAC) inhibitor panobinostat in combination with Velcade and dexamethasone.   Patients progressed on two or more prior therapies, and all had been exposed to immunomodulatory drugs (IMiDs). The overall response rate (ORR) in 17 patients was 43%, primarily partial responses, though another 28% had minor responses. Progression free survival (PFS) and time to progression (TTP) were both 5.4 months. The most common grade 3 or 4 adverse event was thrombocytopenia, occurring in 64%. Peripheral neuropathy was generally mild, and occurred in 27.3%.

  • Dr. Keith Stewart presented the early results of  the phase I MMRC trial assessing the aurora kinase inhibitor MLN5237 in combination with Velcade in relapsed/refractory disease. No steroid was included in the regimen. Nineteen patients have been enrolled, and 16 had prior treatment with stem cell transplantation. Phase 1 is complete, with a maximum tolerable dose of 50 mg twice daily, days 1-7 of a 28-day cycle. The ORR was 26%. Adverse events of grade 3 or greater occurred in 68%. These included myelosuppression, neuropathy, hair loss gastrointestinal (diarrhea, nausea, vomiting), and infection.

Sunday will be a busy day with the start of the oral presentations.  Stay tuned!