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Can New Myeloma Therapies Help When Maintenance Therapy Is Ineffective?

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Published on January 28, 2016

Myeloma expert Dr. Robert Orlowski answers more Ask the Expert questions, this one from Susan: "What effect will newly approved drugs, such as daratumamab (Darzalex) and ixazomib (Ninlaro) have on a patient when lenalidomide (Revlimid) maintenance is no longer effective?" Dr. Orlowski gives a detailed answer, including a newer drug, isatuximab, that he says, "looks like an active and exciting drug."

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Transcript | Can New Myeloma Therapies Help When Maintenance Therapy Is Ineffective?

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:   

Here’s a question we got from Susan, “What effect will newly approved drugs, such as daratumumab (Darzalex) and ixazomib (Ninlaro), have on a patient from lenalidomide (Revlimid) maintenance is no longer effective?”

Dr. Orlowski:     

Well, thanks very much, Susan, for that.  The question about ixazomib is a little bit easier to answer, because in the studies that were done that led to its approval, it was lenalidomide and dexamethasone (Decadron) as the control and ixazomib with lenalidomide and dexamethasone as the experimental arm.  Because lenalidomide was in both of the arms, the study did not enroll patients whose disease was refractory to lenalidomide, i.e., that it was growing on it.  

So we don’t really know the answer about whether adding ixazomib to lenalidomide, if you’re progressing on there, would be of benefit.  With daratumumab, that was done in a relapsed-refractory patient population, and we do know that people whose myeloma progresses on lenalidomide can benefit from daratumumab.  I think actually both of them would be reasonable things to try, but we have more data with daratumumab at this point than we do with ixazomib.  So that might be the way that I would lean if we had a little bit more information just to be sure. 

Andrew Schorr:                  

Just a question now, daratumumab has been approved, and you talked about its sort of broad labeling.  Elotuzumab may be approved in some months, we’ll see, but another monoclonal antibody.  Are all monoclonal antibodies equal, if you will? 

Dr. Orlowski:     

Good question.  I did want to point out elotuzumab (Empliciti) is one of the drugs that was approved in the relapsed setting.  So it’s already available.  It’s tough to say if they’re all equal.  Elotuzumab and daratumumab bind to different proteins on the surface of myeloma cells, and so it’s therefore possible that one could use one antibody. And if the myeloma eventually becomes refractory and grows through it, then you could come back and use a second antibody.

Andrew Schorr:                  

Because they’re different.

Dr. Orlowski:     

Exactly.  They bind a different target.  But we don’t have enough information yet about that to be sure, but I’m sure that by next year’s ASH, if not sooner, people will start to report these kinds of data, because elotuzumab and daratumumab are now being used out in the community as well as at major academic centers.

Andrew Schorr:                  

Okay, and is there still another monoclonal antibody, it was like SAR with a long number, is that still out there somewhere? 

Dr. Orlowski:     

So that one now has a name, by the way, which is always progress.  It’s called isatuximab.

Andrew Schorr:                  

Spell it.

Dr. Orlowski:     

Actually I can, but I won’t. 

Andrew Schorr:                  

Anything.

Dr. Orlowski:     

Not anything.  But it’s another antibody that binds CD38, which is the same target as daratumumab.  It binds a different portion of CD38, so again, it’s theoretically possible that you could use them sequentially.  But we don’t have enough information yet, and isatuximab hasn’t yet been FDA-approved, but it does look like an active and exciting drug.

Andrew Schorr:                  

Right.  Okay, actually, forgive me about elotuzumab, I was around some of the scientists on the day it was approved, so it was very exciting.  And I was with some patients who had been in those trials, and they thanked the scientists, and then the scientists got up and gave them a standing ovation.  It was really, really cool—touching, really. 

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.

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