April 5, 2013

MMRF Newsflash from IMW 2013 - Volume 1

Mid-way through day two of the 14th International Myeloma Workshop (IMW) and already we have heard many thought-provoking presentations and several lively debates on key questions facing the myeloma community. Follow live MMRF posts from IMW on Twitter by searching for #IMW2013. The program at IMW is primarily centered around discussing – even debating – the best approaches for classifying and treating patients which is vastly different than the annual meetings of the American Society of Hematology (ASH) or American Society of Clinical Oncology(ASCO) where the primary focus is new data.

Oral presentations on the first day of the workshop focused primarily on biology, new imaging techniques and related malignancies. The day was capped off with the presentation of the prestigious Waldenstrom’s Award, the highest honor provided to a multiple myeloma expert which is given to one individual at every IMW, to Nikhil Munshi of the Dana-Farber Cancer Institute (DFCI). The MMRF has been privileged to collaborate with Dr. Munshi since our inception, and we are pleased that his commitment to the community and his research focus, primarily in immune therapy, has been appropriately recognized by his peers.

Day two kicked off oral presentations on clinical issues and particularly provocative were presentations around risk-adapted therapy – or as the presenters positioned the question – “should all MM patients be treated with a one-sized fits all approach?”. There were two key debates in this area:

1) for front-line therapy, should there be a one-sized fits all approach or should clinicians pursue a “risk-adapted” approach – debated by Pieter Sonneveld from the Netherlands (no) and Vincent Rajkumar from the Mayo Clinic (yes); and

2) should all eligible patients receive high-dose chemo and stem cell transplant upfront or can it be delayed for some patients – debated by Philippe Moreau from France (yes) and Paul Richardson from DFCI (no).

The key takeaway from both debates was that it is clear that some patients do appear to be “high-risk” and have a worse outcome from initial treatment, but there is a lack of widespread consensus on how to prospectively identify these patients. As one presenter pointed out, there is little overlap between the various risk “signatures” from a number of different groups both in the US and Europe, so, according to one group, a patient could be high-risk and according to another, that same patient could be low-risk. A growing number of experts, led by Antonio Palumbo of Italy, are calling for an end to classifying patients by low-, medium-, and high-risk but instead to classify patients based on specific features.

Another key point was that the vast majority of patients would benefit from a triplet, eg, Revlimid-Velcade-dex or Cytoxan-Velcade-dex, but there are no large randomized trials completed to determine superiority of a specific regimen. Further, most groups do recommend early transplantation for all eligible patients but we do not yet know whether there are specific patients who could safely delay the procedure and still experience the same benefit.

It is clear that currently available classification systems are not sufficient to match patients to treatments most likely to benefit them – with as few side effects as possible – and that multiple myeloma is truly many diseases “collectively called multiple myeloma” (Rajkumar). This is precisely why the MMRF launched the CoMMpassSM study to characterize the disease using the most cutting-edge, robust technologies available to identify the different patient subtypes which will allow the field to better predict prognosis based on a patient’s molecular profile, and, most importantly, identify from diagnosis the best treatments for any given patient based on his/her subtype.

We – the myeloma community – do not yet have the answers but by amassing high-quality data from 1,000 patients in the MMRF CoMMpass study and other similar efforts, by the next IMW, in Rome in 2015, we should have much more predictive models and treatment algorithms which will lead to better outcomes for patients.

It is not too late to sign up for our telephone/web education program Highlights From 14th Annual International Myeloma Workshop being held later today, April 5, 2013 at 5:00-6:00 PM ET / 2:00-3:00 PM PT by visiting: http://www.cancereducation.com/cancersyspagesnb/a/mmrf/mm1303/Register.html