Day Three of the International Myeloma Workshop arrived bright and early this spring day in Paris.
The schedule was filled with important discussions: Secondary Malignancies in Myeloma; Optimizing Patient Outcomes; Newly Diagnosed Patients Over 65; and New Drugs and Therapeutic Approaches.
But no doubt, Revlimid maintenance was the Number One topic of interest because it had previously shown success in extending EFS (Event Free Survival). And today, the IMF announced that a U.S. trial using Revlimid following a stem cell transplant resulted in improved OS (Overall Survival) of 90% at two years, compared to 83% at two years on the placebo.
Further, when folks on the placebo switched to Revlimid maintenance, they also experienced OS gains.
That great news was tempered by a discussion of secondary cancers following long-term maintenance with Revlimid that was first mentioned at ASH 2010 as part of a French study.
Many large studies were analyzed for secondary cancers, and of course, one also needs to remember that as we get older our chances for cancer also increase. Some studies depicted some tendency for Revlimid maintenance arms to show a few more secondary cancers: 1) 8% (Revlimid) versus 2% (placebo) in the French study; 2) 8% versus 2% (U.S. study); 3) 6% versus 3% (Italian study). But in other studies, the numbers were closer to being the same.
In the end, when the panel was asked, "What does all this mean?" I interpreted their responses to be: "There appears to be a small difference--and we'll certainly know more in a year--but at this time it appears the benefit of Revlimid maintenance far outweighs the risk."
And still more drugs are in the pipeline, providing patients more options. Carfilzomib and Pomalidomide are farthest along in Phase 3 trials. HDAC inhibitors (e.g. Vorinostat, Panobinostat) don't seem to work alone, but appear to be synergistic with Velcade and Revlimid. Monoclonal antibodies such as Elotuzumab and Siltuximab are entering Phase 2 trials with Revlimid and Velcade respectively.
As Dr. Kenneth Anderson said today: "When we meet again in two years for the IMW, I'm hoping we can say that myeloma is a chronic illness with sustained CR's in a significant number of patients."
I attended the IMF press conference, which was streamed live to the IMF website, and was designed to help put some of the new data in context. The webcast is archived on the site so that those who missed it can view it at their convenience.
The last day of meetings begins at 7:45 a.m. In the afternoon, I'll be at the IMF patient-family seminar.