May 5, 2011

Updates from Day 2 at IMW, Sandra Wear

Day 2 kicked off a full day of sessions beginning with a discussion around the treatment of newly diagnosed patients who are not eligible for high-dose chemotherapy and stem cell transplant (SCT) with leading clinicians from around the world – US, France, Germany, Italy, Netherland, Spain and the UK sharing their individual perspectives. While treatment patterns differ by country, particularly because some treatments like Revlimid are not widely available outside the US for first-line treatment, encouragingly, when treatments like Revlimid and Velcade are used – regardless of the combination, we are virtually seeing everyone achieve a response though the depth and duration of response does vary between individuals.

So, the ongoing question remains whether, now that we have such highly effective combinations that include proteasome inhibitors and immunomodulatory agents (IMiDs) as backbone therapies, the high dose chemotherapy and SCT should remain as a standard treatment for younger patients (see tomorrow’s highlights for more discussion on this topic). And, as recently as the ASH meeting in December 2010, the impressive results in terms of delayed disease progression from the use of prolonged maintenance therapy post-SCT has given rise to more questions about whether we need to consider incorporating this into standard of care for patients. Possible answers may come out of a newly opened trial being led in the United States by one of MMRC’s member institutions – Dana-Farber Cancer Institute and in France, by the IFM. The IFM/DFCI randomized trial will enroll 1,000 patients in the US and France and will examine the role of high dose chemotherapy followed by SCT in the era of novel agents (is high dose chemo + transplant + novel agents needed, or not, to achieve a good level of response when compared to using novel agents alone?) and is maintenance therapy something we must seriously consider for use in future (is it effective or not at prolonging a patient’s initial response, regardless of the initial treatment and, for how long should it be administered?).

High risk myeloma was also covered in depth at this meeting with the MMRF’s Nature paper with sequencing results from the MMRF-funded Genomics Initiative once again garnering recognition for its contribution to our increased understanding of myeloma tumor cell biology. High risk presentations highlighted how complicated the MM biology really is – and not just at time of diagnosis as there can be multiple myeloma “clones” within one individual, and, as an individual’s disease progresses, new clones can emerge. New genomic discoveries have provided early direction in terms of druggable targets not previously explored in MM. Briefly, we can focus on drugs to address abnormalities of the BRAF cellular pathway and over-expression of a protein called MMSET which is clearly present in patients that have t(4;14) multiple myeloma. Although the myeloma tumor cell by nature is a ‘survivalist’, the only real way we can keep it at bay is by deepening our understanding of how it operates and have ready at hand all of the tools needed to overcome its peculiarities every step of the way.