Published on June 11, 2019
From May 31 to June 4 I attended my first American Society of Clinical Oncology (ASCO) annual meeting at McCormick Place in Chicago, Illinois. I was able to attend this meeting thanks to a generous scholarship I received from the Conquer Cancer Foundation. The first annual meeting of ASCO was on April 9, 1965. Sixty doctors attended. The scientific program focused specifically on leukemia and multiple myeloma. This meeting has grown over the years. The current meeting gathered more than 25,000 oncology professionals. The focus is no longer just leukemia and multiple myeloma, but all cancers.
McCormick Place is huge. I had no problem putting 10,000 steps on my Fitbit each day. Thankfully I have attended the American Society of Hematology’s (ASH) annual meeting in the past. Having this experience helped me successfully navigate ASCO. I attended oral and educational sessions about myeloma. I listened to researchers present their findings during poster sessions and visited many industry displays in the exhibition hall. I was also granted access the Patient Advocate Lounge where I was able to network with other advocates from different cancer types.
Although ASCO cannot compare to ASH in the number of myeloma abstracts that are being presented, I was presently surprised with the new myeloma data shared at this meeting. There was something for everyone. Besides updates on trials, there were a few sessions addressing the disparities in myeloma treatment and outcomes. Disparities in myeloma care existed particularly among individuals who lived in rural communities in the United States or who were among minority populations. These individuals tended to have poorer outcomes. Conversely factors such as having private insurance, living in a regionally higher income area and receiving treatment at academic institutions lead to longer survival for multiple myeloma patients.
Dr. Maria-Victoria Mateos presented an updated risk stratification model for smoldering myeloma incorporating the International Myeloma Working Group’s (IMWG) diagnostic criteria. She discussed factors that were independently associated with progression from SMM to active myeloma within two years. These factors included a Serum M-Protein level of 2 g/dL or greater, a ratio 20 of the involved light chain to the uninvolved light chain, and 20 percent or more plasma cells in the bone marrow. (2/20/20 Risk Progression Model) Individuals with at least 2 risk factors were classified high risk smoldering myeloma (HRSMM). Intermediate risk patients had one risk factor, and low-risk patients did not display any risk factors.
Another abstract of interest to the smoldering myeloma community was a trial on early intervention. Dr. Sagar Lonial presented results from a randomized Phase III trial of lenalidomide vs observation alone in patients with HRSMM. His conclusions stated, “Based upon our trial and the earlier Spanish trial, we recommend early intervention for patients with HRSMM using the Mayo 2018 IMWG criteria.” This trial may support change in the current standard of care for HRSMM.
NEWLY DIAGNOSED MYELOMA(NDMM)
Another abstract that received a lot of attention was Kyprolis/Revlimid/dexamethasone (KRd) with or without transplant in newly diagnosed multiple myeloma patients (NDMM). Both arms of the trial were found to be equally effective in terms of overall response rate, but for high-risk patients an autologous stem cell transplant (ASCT) reduced the rate of early relapse. Longer follow-up is needed to properly assess Progression-Free Survival (PFS) and Overall Survival (OS).
Dr. Phillipe Moreau presented results to the CASSIOPEIA trial- D-VTd (daratumumab, Velcade, thalidomide and dexamethasone) vs VTd in transplant eligible patients. This trial mainly accrued in Europe that is why Thalidomide was used instead of Revlimid. Dr. Moreau concluded, “D-VTd therapy resulted in a robust clinical benefit that was both statistically significant and clinically meaningful compared to VTd alone. D-VTd should be considered a valued treatment option for NDMM patients who are eligible for an autologous stem cell transplant.”
RELAPSED REFRATORY MYELOMA (RRMM)
Some exciting results were also presented for patients with relapsed or refractory disease. There may be some new tools in the toolkit we use to treat myeloma soon. AMG-40, an anti-BCMA bispecific T-cell engager (BiTE) continues to perform well. At present it is a 24-day continuous infusion, but Amgen is working on this drawback. My comment on Twitter was that I hope that the backpack (pouch) the patient will need to wear for 24 days is stylish!
Isatuximab (Isa) may be another new tool. Isatuximab is an anti-CD-38 monoclonal antibody like daratumumab. Dr. Richardson presented data that showed a combination of Isa/ Pomalidomide/Dexamethasone had consistent clinical benefit and a manageable safety profile.
Additionally, Celgene is introducing a new CELMod to its myeloma arsenal. Their new therapy is an oral medication called Iberdomide (IBER). IBER is currently is in a Phase 1B/2A study. IBER plus dexamethasone showed activity and a good safety profile in individuals with heavily pretreated RRMM. More importantly overall response rate in patients refractory to lenalidomide, pomalidomide and or anti-CD 38 antibody therapy was similar to that observed in the whole cohort.
GSK’s anti-body conjugate now has a name! It is called Belantamab Mafodotin. (that’s a mouthful!) This anti-body drug conjugate continues to perform well. Many of the myeloma doctors that I chatted with at ASCO believe that it may be approved within the next 12 months.
As a patient, one of the abstracts that I found most exciting was a non-inferiority study of Daratumumab given by sub-cutaneous injection (Dara SC) vs daratumumab given by intravenous injection. (Dara IV) This study showed that Dara SC was not inferior to Dara IV. Dara SC had a lower incidence of infusion rate reactions and injection site reactions. Patients treated with Dara SC reported higher satisfaction to therapy. If the FDA approves this method of administration patients will spend less hours in the clinic.
I returned from ASCO tired but invigorated. (and with a new iPad! - I won the drawing at the reception hosted by the Rutgers Cancer Institute of New Jersey) I’m anxiously awaiting the American Society of Hematology’s (ASH) meeting in December to hear more about the latest happening in the field of myeloma research.
By Cindy Chmielewski - @MyelomaTeacher
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Keep up the great work! You are my go-to source for the latest myeloma news.