Today was a busy one, having just returned from a meeting that ended at 10pm...but more about that later. A couple of interesting posters focued on Carfilzomib, noting no evidence of late-onset toxicity with long-term usage (median 22 cycles), and Pomalidomide-Dex-Doxil possibly being an effective treatment for Rel/Ref MM patients.
Onto oralb presentations...the first about a cd38 monoclonal antibody call Daratumumab [Ok, so it's hard to pronounce but what about its benefits?] A small Phase I study of 32 patients at varying dosages resulted in 4 pts PR (13%), 6 MR (19%) and 5 SD (16%), which is very good for single agent activity. It was well tolerated, which is worth noting because cd38 is expressed in normal cells as well. And staying with antibodies, the CS1 antibody called Elotuzumab continues to show good results when combined with Rev-dx (14% CR, 92% ORR). Although these patients were rel/ref MM, they had not taken Rev before. A future trial call Eloquent (clever) will provide more complete results.
Several other oral presentation provided good results for Carfilzomib (Cfz)-Pomolidomide (Pom)-dx, Biaxin-Pom-dx, and Pom-dx regimens. While Pom was typically tested at 2mg & 4mg dosages and will likely receive FDA approval in 2013 at the 4mg dosage, the lead investigator Dr. Martha Lacy (Mayo) said "2 mg works just as well as 4".
And a Phase III trial compared VMPT-VT with VMP, looking at the impact of adding Thalidomide to induction as well as maintenance along with Velcade. The more robust regimen certainly resulted in higher PFS (35 vs 25 mos) and 5-yr OS (61% vs 51%) but neuropathy was certainly a side effect.
My day ended with a very educational and inspirational workshop for International Journalists. There were approximately 100 in attendance, many with headsets providing real-time translation, and also streamed live to 20 countries. Susie Novis (IMF President) explained that 1 million patients worldwide are living with MM and "MM knows no boundaries, so why should treatments stop at the border?."
MM experts Drs. Brian Durie, Paul Richardson, Robert Orlowski and Xavier Leleu (France) described the evolution of MM therapies with special emphasis on Pom and Cfz, but also antibodies (mentioned earlier) and other (future) treatments options such as Rev-Vel-dx + Vorinostat, MLN9708 (oral proteasome inhibitor) + Rev-dx, and Subq Velcade-Cytoxin-dx. So many options...at least in the US. However, this isn't the case for a country like Brazil which still hasn't received approval for Revlimid.
One last note about Pom and Cereblon, an expressed protein that seems to correlate with efficacy of Thal and Rev. However, Dr. Durie explained that Pom seems to work even if Cereblon expression is low!
Well, that's about it for the day. Lots of information, and yet tomorrow is also known as "Myeloma Monday" with oral presentation going from 7am - 6pm. And then I'll be watching the Myeloma IMWG Debate Round II tomorrow evening (check the IMF website myeloma.org for more details).
It's late and I have a 5:25am wake-up call.