Myeloma was very prominent at ASH today with interesting new abstract reports and oral sessions. One of the first impressions we had was the great interest in our cancer. Very large rooms with sessions on myeloma were overflowing, at the same time dozens of simultaneous presentations on other hematologic topics were occurring.
Promising drugs, treatment combinations, and novel trials have been discussed, but I have seen no blockbuster standout at this year's ASH. Many will not work out. All add to our knowledge base and all are important in combating this wretched cancer. Clinical trials take time to accrue and eventually "mature". Hopefully by next years meeting, a standout drug will be emerging. None of this paragraph should be read as discouraging, just realistic. Research and clinical advancements take lots and lots of time.
The two best agents coming are Pomalidamide and Elotuzumab. Pom has great promise to be FDA-approved by February 10 (it's (PDUFA date). Elo is a monoclonal antibody directed against a substance found on the surface of myeloma cells called cs1. It shows rapid response, and in a group of patients being treated by Dr Paul Richardson an ORR (overall response rate) of 100% was seen. It even shows considerable activity in the 15% of patients with high risk disease.
The next best hope centers on an oral proteosome inhibitor MLN9708 which will also be called ixazomib. It is quite promising in late phase trials. Another oral PI by Onyx called Oprozomib has clinical potential, but also considerable GI toxicity (nausea, vomiting, diarrhea).
This evening foreign journalists from around the world were given an update on important myeloma information being presented at this year's ASH. Some of their questions and comments reflect frustration at unavailability of newer novel agents in their own countries. We were all saddened to learn that an eight year old child was recently confirmed to have multiple myeloma in Brazil. We have made good progress toward a cure, but we still have a long way to go.