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ASH 2018 Daily Wrap: Myeloma News

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Published on December 4, 2018

In day two of Patient Power’s daily wrap-up from the 2018 American Society of Hematology (ASH) meeting in San Diego, Patient Power founders Andrew and Esther Schorr are joined by a panel of leading experts, including Dr. Gareth Morgan, from The UAMS Myeloma Institute, Dr. Mohit Trikha, from Triphase Accelerator Corp., and host and patient advocate Jack Aiello, who has been living with myeloma since 1995, to discuss news from the meeting and share research highlights. The panel discusses impressive treatment advances and important headlines in clinical research, particularly related to multiple myeloma, and captures the state of myeloma care today. Watch now to find out the latest news from ASH 2018. 

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Transcript | ASH 2018 Daily Wrap: Myeloma News

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That's how you’ll get care that's most appropriate for you.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

And hello from San Diego. I’m Andrew Schorr with Patient Power. This is the second of our daily wrap ups from the American Society of Hematology meeting where there are experts—more than 20,000 people from around the world discussing blood-related conditions and blood related cancers. Today, —we’re going to talk a little more structured in multiple myeloma. But we’ll broaden it out. We invite you to send in your questions to [email protected]. This is my colleague of 33 years. And you are?

Esther Schorr: 

Yes. I am Esther Schorr. Nice to talk to all of you. And I have spent most of the day today talking to other clinicians and researchers about multiple myeloma in specific. And I just can’t wait to hear what our panel here has to say. Because it sounds like there’s so much exciting stuff going on.

Andrew Schorr:           

Well, let’s introduce our panel. So, first of all, a dear friend who’s been living with myeloma more than 20 years, Jack Aiello—also a Californian. Jack, thank you for being with us.

Jack Aiello:     

It’s my pleasure. I’m lucky that the International Myeloma Foundation has sent me here to view ASH and take back information to our patients.

Andrew Schorr:           

Right. Very devoted.

Esther Schorr: 

Do that.

Andrew Schorr:           

And sitting next to you, Dr. Gareth Morgan who’s been with us before from UAMS or—let’s see. Let me get it right what that stands for.

Dr. Morgan:     

University of Arkansas Medical Sciences, so based in Little Rock.

Andrew Schorr:           

And you hear his Southern accent.

Dr. Morgan:     

Yeah.

Esther Schorr:             

Right. Right from Down Under.

Dr. Morgan:     

Nice to see y’all.

Andrew Schorr:           

Okay. And also, last year—and our interest has been really to not just talk about what’s now, but what could be coming and how does it happen. And so, I had the pleasure last year of meeting a gentleman who is a scientist and who helps supervise many other scientists in cancer and is really devoted to that. And that is Mo Trikha. Mo, what’s your role? What’s your title?

Dr. Trikha:       

So, thanks for having me. My title is I’m Vice President and Head of Oncology Early Development at AbbVie. And my job basically is to work with scientists and clinicians and bring in new molecules from the lab to what we call clinical proof of concept trials in cancer patients.

Esther Schorr: 

You’re really at the front end of everything.

Dr. Trikha:       

Yes, well…

Andrew Schorr:           

…what could be next?

Esther Schorr: 

What could be next? Yes.

Andrew Schorr:           

So, when we talk about molecules, right? And now, in some conditions, can we have a better second generation medicine and class of medicine? How do they fix those molecules? How do they make it better? Fewer side effects? Maybe you don’t have to take it as often. Maybe it can be oral rather than infused. We’re going to find out about how you do that. So, ask questions about science as well. But shall we start with Jack and get?

Well, first of all, you’ve been doing interviews with some other experts. Bob Orlowsky from MD Anderson. What’s the mood related to myeloma?

Esther Schorr: 

Well, very exciting. And I think you all will probably reinforce that. But what I was hearing was that combinations of different kinds of treatment—whether it’s monoclonal antibodies combined with what is standard of treatment now—and that there are just so many more choices than there have ever been. And that’s really the headline. The other thing that I was hearing—and maybe we can talk a little bit about that—is there’s a lot of discussion about CAR T-cell therapy and that at some point could very well be something that is very useful in multiple myeloma.

Dr. Morgan:     

So, I think you’re completely right. The CAR T thing is moving on very rapidly. Basically last year, it was a little bit of stuff. This year, we’re seeing the kind of Phase I data reading out.

And by next year, we’ll start to see clinically useful, potentially randomized data sets that lead toward registration. So, I think it’s a really exciting time for patients.

Andrew Schorr:           

All right. So, just so everybody understands that. Right now, that’s making a drug out of your T cells. Giving your T cells sort of…

Esther Schorr: 

…Hamburger Helper.

Andrew Schorr:           

Hamburger Helper to the gym. Make them super powerful. And have them have a target to go after. Mo, did I get it right? It’s with T cells what you’re doing?

Dr. Trikha:       

Yeah. You absolutely got it right. You know, I’m sitting here reminded of—before we started, you were talking about yoga. And a few years ago, my wife dragged me into taking a yoga class. And one thing the yoga teacher said that is relevant to what we’re saying here was he said, “Your body is a pharmaceutical factory. Every day, we fight infections. We have cytokines.”

And so, what I find absolutely remarkable about CAR T therapy—which is chimeric antigen receptor—you take your own T cells. You take them out of your body. You genetically manipulate them. You grow them. And then we’ve learned to put them back in. In a way, we’re using our own body’s immune system to fight cancer in a very selected way. Perhaps that is the way to take it forward. Our body is a pharmaceutical factory. And if we learn how to do that, we can fight cancer.

Andrew Schorr:           

Okay. We’re going to talk a lot more about this sort of immune approach. Jack, what’s your—rest you. You’ve been to how many ASH?

Jack Aiello:     

I think this is my 13th or 14th ASH.

Andrew Schorr:           

And you go to meetings in Europe.

Jack Aiello:     

I do. I do.

Andrew Schorr:           

So, what’s impressed you this time?

Jack Aiello:     

Well, you know, Dr. Morgan and I were talking earlier. It’s been about four years since I’ve seen him and gotten a chance to talk with him. And I was thinking back what’s happened in those four years.

There have been at least four or five drugs approved. There have been different treatment protocols approved for different lines of therapy. And now, the whole discussion topic—much of the discussion topic is on immunotherapies that you talked about. In addition to CAR-T therapy, we already have some monoclonal antibodies approved. But there are expansions of monoclonal antibodies to something called antibody drug conjugates. Where these monoclonal antibodies—as I understand it—kind of bring in a poison to…

Dr. Morgan:     

…sort of a payload.

Jack Aiello:     

That’s exactly right.

Andrew Schorr:           

Like a payload. Yeah.

Esther Schorr: 

Cruise missiles.

Jack Aiello:     

And there are these BiTES—which I think is a fabulous name—which are connecting your T cells to the tumor cell and doing a better job at getting rid of them. So, it’s exciting, Andrew. That’s the best way I can answer it.

Andrew Schorr:           

Mo, what’s a BiTE? What is this? Hold your mike there.

Dr. Trikha:       

So, what the BiTE is it’s an ability to take two antibodies. So, think of a monoclonal antibody. So, we had first generation. We had a monoclonal antibody that would bind to a certain antigen or a target on a cancer cell. And that was called monoclonal. Through genetic engineering and molecular biology, what we’ve been able to do now is one side binds to the cancer cell, the myeloma cell. The other side binds to a T-cell receptor. So, that’s a CD3 receptor, for example. And then by bringing those two together in the right position, what you’re able to do now is that those T cells can now attack and kill those myeloma cells.

So, that’s what this version of a BiTE that’s coming out that is showing really profound—so, we just talked a little bit earlier about CAR Ts, which was basically you take the cells. You engineer them. You put them back into your body. And those cells will then attack. This is a different way of activating those T cells that will kill your cancer cell—the myeloma cell in this case.

Andrew Schorr:           

Now, if I understand correctly, the BiTES though might be kind of an ongoing treatment, right? Whereas CAR T is maybe a once only?

Dr. Trikha:       

Yes. So, the idea with a BiTE is—so, you sometimes—with the first generation that we tested that we brought forward is what requires continuous infusion. Because they have—they disappear from your body. They have what’s called a faster half-life or faster clearance, a shorter half-life.

Now, scientists are starting to make what we call second generation BiTES or second-generation BiTE specifics, which perhaps you can inject once a week, maybe even once every three weeks. Whereas with the CAR Ts, originally we were talking about—and there’s some data coming out like Morgan talked about. These are single infusions. And you give them once and then you see a response.

Esther Schorr: 

Can I ask—I have a question then.

Andrew Schorr:           

Yeah, sure.

Esther Schorr: 

There’s a lot of working with T cells here. And is there some retraining that’s going on? Like once one of these treatments is done do your T cells potentially learn something that they…

Andrew Schorr:           

,..do they remember?

Esther Schorr: 

Do they remember stuff?

Dr. Morgan:     

It’s back to the days of blindfolding your T cells. Your immune system can’t see the cancer. And they use like the Klingon cloaking device. The tumors are blind to the immune system. And what you’re saying is completely correct.

You’re retraining the immune system to see the cancer cells. And so, you can see it has a different mechanism. It’s the T cell killing that probably combines with chemotherapy, anti-apoptosis drugs. So, we have the chance to build curative regimens and push patient survival out in the upfront setting.

Esther Schorr: 

Okay. That helps.

Dr. Trikha:       

What happens is there really is a memory. So, to your point, are we training? These T cells are fascinating. Once they—you can reactivate that memory. And you can get these T-cell memory cells to further get activated. And that’s kind of where we’re thinking about the next frontier is to say you activate the T cell. It fights the cancer. If the cancer subsides, if it relapses, could you reactivate those T cells again?

Esther Schorr: 

So, could there then be a stop in treatment at some point if you use one of these therapies?

Dr. Trikha:       

Ideally, the CAR T’s a one and done.

Esther Schorr: 

So, you’ve done the training and they go off, and they do their thing.

Dr. Trikha:       

They come in. They do their job. And they either exist there long term where they’re still effective.

Jack Aiello:     

Right. Proliferate. But we don’t know how long it lasts.

Esther Schorr: 

Right.

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