So, as I mentioned previously, today is Myeloma Monday, meaning the first oral presentation began at 7am and the last one ended at 6pm. Yes, we had some breaks but I used them to review the new posters and walk to different rooms in the large Convention Center. Each presentation is about 13 minutes with 2 minutes of q&a's...and the 15 minute time limit is monitored very closely.
Here's a sample presentation title: "A Phase 1/2 Study of Weekly MLN9708, in Investigational Oral Proteasome Inhibitor, in Combination with Lenalidomide and Dexamethasome in Patients with Previously Untreated Multiple Myeloma (MM)." The Powerpoint presentation topics typically cover Background, Trial Rationale, Treatment Plan, Patient Demographics, Trial Results (Responses, Survival Outcomes, Adverse Side Effects), Conclusion, and Future Directions. I'm watching slides fly by at real time speed, all the while trying to record accurate information and listen to what's being said. It's pretty intense as you listen to the terminology (for example, we know Lenalidomide as Revlimid) and try to interpret the results.
Today I heard good results for Newly Diagnosed patients with MM, including the regimen mentioned above (MLN9708-Rev-dx). Others included:
- Rev-Vel-dx (RVd) + Vorinostat
- Cytoxin-Cfz-Thal-dx ("CYCLONE")
[Sorry...I see I use both "+" and "-" to mean "with".] And there were certainly presentations for Relapsed-Refractory MM patients:
- Pomalidomide-Cytoxin-Prednisone (PCP)
- Tabalumab (anti-BAFF Antibody) + Velcade
- ARRY-520 (KSP Inhibitor) with or without dex
- Lorvotuzumab Mertansine (LM, an antibody-drug conjugate) + Rev-dx
And I also listened to several presentations about transplants (SCT) and Maintenance:
- Maintenance after SCT with Vel-Thal vs Thal vs Interferon
- SCT outcomes '95-99, 2000-'04, and '05-10
- Comparison of Induction (with poor response results) followed by 1) SCT or 2) "salvage" therapy (to improve response), followed by SCT. [Turns out it doesn't matter.]
So how's a patient to know as well as your oncologist decide what's best for you? So many options lead to so many choices lead to so many questions. This MM is really a very clever animal...once you think you've beaten it, MM figures out another pathway or another cell surface protein, or gets help from the surrounding environment to figure out a clonal variation or itself to avoid cell death.
While typing this, I'm watching a wonderful IMF-sponsored debate among MM experts Drs. Durie, Polumbo, Rajkumar, and Richardson. If they disagree on first-line treatment, 2, 3, or 4 drug regimens, and maintenance, how are we to know? We all want the "best" treatment and get frustrated not having definitive answers. Well, let me tell you what's worse...having only 2 treatment options Melphalan-Prednisone or VAD inductio + SCT and told the average life-span is only 2-3 years. That was my choice 18 years ago. Personally, I'm much happier having more and much more effective/less toxic options.
ASH ends tomorrow morning so my final blog report will probably be written from the airport or after I return home. I'm looking forward to both.