December 9, 2013
MMRF Newsflash from ASH 2013 - Volume 3
Welcome to our third report on the 2013 American Society of Hematology (ASH) Annual meeting, featuring many posters on multiple myeloma.
Highlights from Sunday’s session included:
Newly diagnosed patients
Dr. Kourelis of the Mayo Clinic reported on an analysis of continuous therapy in newly diagnosed multiple myeloma patients who remained on Revlimid (lenalidomide) for more than three years and compared them with patients who discontinuing Revlimid and were able to maintain disease control on observation. This study found that patients with standard risk cytogenetics and a very good partial response or better were more likely to be long-term responders, and that long-term responders were more likely to be slow responders. Though the absolute number of patients analyzed was small, the results further suggest that patients with a very good partial response or better may be able to stop Revlimid therapy after one year without any greater risk of progression.
In elderly newly diagnosed patients, Dr. Baz of the Moffitt Cancer Center showed that “response adapted” therapy, that is Revlimid alone followed by dexamethasone rather than Revlimid and dexamethasone together, was effective in elderly transplant ineligible patients. The outcomes were similar to those in younger patients treated with the doublet therapy.
Dr. Kumar from the Mayo Clinic presented an analysis comparing newly-diagnosed patients who had been treated with Velcade, cyclophosphamide, and dexamethasone (VCD aka CyBorD) versus Velcade, Revlimid, and dexamethasone (RVD) as upfront treatments. The analysis showed that the overall response rates, progression-free survival, and overall survival of patients treated with these regimens were similar, and that the toxicities of the treatments were also similar.
Dr. Mark from Weill Cornell presented preliminary results from Car-Bird (Kyprolis-Biaxin-Revlimd-dex), which had previously been studied in relapsed and refractory patients. The overall response rate was 87% with is consistent with other upfront studies using a prosteasome inhibitor and IMiD and with longer follow-up, the rate could increase. There were a number of Grade 3-4 toxicities including two cases of renal failure and one of congestive heart failure so it will be important to closely monitor patients on this regimen.
A number of abstracts were presented looking at the addition of bendamustine, an older chemotherapy drug, to Velcade and /or Revlimid. In the elderly, non-transplant population, overall response rates were close to 90%. Grade 3-4 hematologic adverse events were approximately 40%, so particularly in light of other studies presented at the meeting, it will remain to be seen whether this is an optimal regimen for this population.
Dr. Usmani of the University of Arkansas for Medical Sciences in Little Rock presented the final results of a Phase II trial of Pomalyst in heavily pretreated, GEP-defined high risk relapsed/refractory patients. The results show that Pomalyst alone or combined with dexamethasone is active in this subgroup of patients.
Dr. Baz of the Moffitt Cancer Center presented results of Pomalyst and dexamethasone with or without cyclophosphamide in Revlimid-refractory patients. Results by arm were not reported, but the regimens are active with an overall response rate of 48.5% so far in this ongoing study which is encouraging in this population.
Dr. Weisel performed a subset analysis of elderly patients from the Phase III study of Pomalyst+Low-dose dex vs. High-dose dex and found that those patients responded as well and experienced similar toxicities as compared to their younger counterparts in the study, suggesting that this combination is feasible and effective in this population.
Early results were reported for several new agents, including the anti-KIR antibody, IPH2101 with lenalidomide, the Pan-Pim Kinase inhibitor, LGH447, and the selective histone deacetylase 6 inhibitor, ACY-1215, in very small patient populations. In each, there were patients who had a partial response or a very good partial response, which is encouraging; however, more patients need to be enrolled and followed to ensure each drug is safe enough to move forward and determine the right dose.
MMRF ASH Coverage
To see the full MMRF coverage from ASH with ongoing updates, please visit: www.themmrf.org/ash2013.
The MMRF Highlights From the 2013 ASH Annual Meeting Webcast/Teleconference will be held on Wednesday, December 18, at 1:00 PM ET! Hear our experts' perspectives on key myeloma clinical updates from ASH and learn about the latest advances in myeloma research and treatments. Register now by completing this form or calling 1-877-264-4949.