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Myeloma Treatment Research Updates: Highlights From the 2018 ASCO and EHA Meetings

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Published on August 20, 2018

What’s the latest news in multiple myeloma treatment? A panel of experts including Dr. Joshua Richter, from Mount Sinai School of Medicine, and Dr. Amrita Krishnan, from City of Hope, share exciting advances in myeloma research announced at the 2018 American Society of Clinical Oncology (ASCO) and European Hematology Association (EHA) meetings. The panel discusses clinical trial data and patient response news on combination therapies, proteasome inhibitors, CAR-T cell therapy and a study examining the dosage and regimen of Kyprolis (carfilzomib). Watch now to stay up-to-date with treatment developments for myeloma.

This is a Patient Empowerment Network program produced by Patient Power. We thank AbbVie, Inc., Celgene Corporation, and Takeda Oncology for their support.

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Transcript | Myeloma Treatment Research Updates: Highlights From the 2018 ASCO and EHA Meetings

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.

Jack Aiello:

Doctors Krishnan and Richter, let me ask you another question.  In June it's always a big month, ASCO happens, the clinical oncology conference in Europe they have something similar, EHA.  Can you give us some insights?  I'll start with Dr. Krishnan.  What were some of the highlights that came out of those large cancer conferences for myeloma patients?   

The other thing I would highlight was the CAR T?cell data, which I think of huge interest to patients. This is now an expansion cohort. So the initial data we saw was in about 20 patients.  Now we have data—it's still not huge numbers, 40 patients, but what we did see was that the response rates remain very high, about an 80 percent response rate.   

We learned some interesting things that previous trials and the CAR?T in this construct, the Bluebird trial, targeted BCMA.  And the initial phase of the trial required that the patient have a certain amount of BCMA expression on their plasma cells.  And that was actually a hard target to get.  Some patients were excluded.  What we learned in the expansion phase is that the percent of BCMA expression on the myeloma cells really didn't matter in terms of response. And that as an (?) Inaudible criteria is no longer an issue moving forward.   

We learned that the cell dose of T cells infused matters in terms of response, that there is a certain minimal threshold of T cells needed.  And we also did learn in terms of toxicity signals that we do see cytokine release.  Fortunately in the majority of patients it's been mild.  I would think those are the two biggest highlights.   

And the other one I wanted to briefly touch upon was the study looking at weekly carfilzomib.  So it looked at weekly compared to a traditional carfilzomib schedule, and showed that a weekly higher dose was tolerated well. Interestingly, we actually saw a better progression?free survival in the patients receiving weekly compared to the twice a week.  I haven't drilled down enough yet in that trial to know is that because of toxicity, or what are the reasons, but it just shows us that you can give weekly higher dose carfilzomib.   

The other studies that I would high rights that came out of EHA and ASCO this year focused on combination therapies.  It is still a goal if we can in patients to put them on multi?drug combinations using multiple different mechanisms of action to treat the different types of subclones within the disease.  So there has been data recently on three? and four?drug combinations and how they may benefit patients.  

So the combination of elotuzumab (Empliciti), pomalidomide (Pomalyst) and dexamethasone (Decadron), the data was presented at EHA and was very encouraging as a really great option for patients with relapsed myeloma as well as that same combination, elotuzumab, pomalidomide and dexamethasone with bortezomib added to that.  A four?drug combination, but again in the right population this can be both tolerated and efficacious, as well as the three?drug combination of Velcade, pomalidomide and dexamethasone.  

And I know a lot of this may seem like, you know, they used to call it word salad where you're just mixing up different letters and combination and it doesn't all make sense, but that's part of what our collective job here is to look at all the different options and all the data and drill that on what the exact correct regimen is for an individual patient.  For some patients four or three drugs may be too many and two drugs may be appropriate, but in the right patients we may need to combine three or even four drugs to get the response needed.   

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.