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A Day Full of Myeloma Studies Capped by an Evening of Education and Inspiration

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New Orleans, LA December 8, 2013--Today was a busy one, having just returned from a meeting that ended at 10 p.m., but more about that later.  I'm sure a highlight for any presenter at the annual meeting of the American Society of Hematology (ASH) is to be selected for a Plenary session. This is a 30-minute oral presentation with no other competing talks. As such, several thousand attendees are in the audience.

One of today's Plenary session talks was given by Dr. Thierry Facon from France about Phase III trial results for 1,623 (!) newly diagnosed myeloma patients, at least 65 years old, who were randomized into 3 study arms: (A) Revlimid plus dexamethasone until disease progression; (B) Revlimid plus dex for a fixed 18 cycles (72 weeks); and (C) Melphalan-Prednisone-Thalidomide for a fixed 12 cycles (72 weeks).

Results for Arms (A), (B), and (C) respectively showed:

  • Overall Response Rate (%): 75  73  62
  • Progression-Free Survival (mos):  26  21  21
  • Median 4-yr Overall Survival (%):  59  56  51

While some of the numbers may look close, there are important differences as you drill deeper.  For example, PFS curves for (A) and (B) were very close through 18 months, but then the curve separation became apparent and growing.  Another factor supporting (A) as the preferred treatment was that (A) had a 1-year improvement over the others in a measurement called Time-To-Progression. And while Arms (A) and (B) both had about 28% grade 3-4 neutropenia (low white count), Arm (C) had 45%.

I've highlighted a few posters [abstract number] below:

  • Poster [3178] compared outcomes for Velcade-Cytoxin-Dex (CyBorD) versus Velcade-Revlimid-Dex (VRD) for newly diagnosed patients. Besides comparable PFS (70% vs 68% at 2 yrs) and OS (92% vs 85% at 2yrs), cost was also examined.  The cost for 4 cycles CyBorD versus VRD was $37K vs $67K.  Both costs are outrageous but I'm glad to see studies looking at this.
  • Phase III study in Poster [3189] showed that Perifosine with Velcade plus Dex in patients previously treated with Velcade showed no benefit in PFS or ORR. It's also useful to eliminate some drug usage.
  • Poster [3209] examined responses to Revlimid in newly diagnosed patients with and without continuous therapy. It demonstrated that patients stopping Revlimid after 1 year and achieving a VGPR or better can result in long-term (4 yrs) disease control and can be considered a treatment strategy. 

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.  A summary of several ASH highlights was presented along with future goals of developing better treatments, perhaps at earlier diagnosis, and build upon the IMF's Black Swan Research Initiative to have better testing tools (Minimum Residual Disease) that more accurately determines patient responses. 

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 7 a.m. to 8p.m.  And then I'll be watching the International Myeloma Working Group (IMWG) conference series tomorrow evening (check the IMF website myeloma.org for more details).

It's late and I have a 5:30 am wake-up call.  

-- Jack Aiello

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