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Treating Myeloma in Patients with Renal Insufficiency

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Published on June 16, 2020

For myeloma patients whose kidneys are impaired, what treatment options are available to them? Renal impairment often excludes patients from clinical trials, so learning has to come in other ways, like observational studies.
In this segment from our recent Answers Now program, patient advocate Maddie Hunter shares results from three kidney related abstracts from the 2020 American Society of Clinical Oncology (ASCO) meeting. Watch as she and host Jack Aiello discuss if and how a standard treatment approach can benefit newly diagnosed patients who have renal insufficiency. They also discuss a new drug in development and a new bisphosphonate option.

This is the fourth part of a five-part series. Watch Part 1 at What Does the ENDURANCE Trial Mean for Myeloma Patients?, Part 2 at CAR T-Cell Clinical Trial Updates for Myeloma Patients, Part 3 at What Does the StaMINA Trial Mean for Myeloma Patients? , and Part 5 at New Treatment Options Give Hope to Myeloma Patients .


Transcript | Treating Myeloma in Patients with Renal Insufficiency

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.

Recorded on June 5, 2020

Jack Aiello:

 I want to welcome my fellow patient advocates. We have Cindy Chmielewski from New Jersey joining us, I have Maddie Hunter from outside of New York City joining us, and Jim Omel from the great state of Nebraska with us. And together, we're going to talk about key takeaways that each of us saw at ASCO.

So just to give you some background, what the heck is ASCO? Each June researchers from around the world gather to share their findings in Chicago, except this year with the COVID-19 this sharing of discoveries was done virtually. But nearly 43,000 attended from 138 countries to provide both oral and poster presentations with prerecorded videos and slides.

While ASCO predominantly focuses on solid or tissue cancers, there were several excellent updates provided for the myeloma community. Why do you care about this? Well, with new research, it could change your treatment plan. The research could provide you with questions to ask your doctor. And ultimately like me, I think it gives you hope.

Maddie Hunter, let me ask you to introduce yourself. And I know you're going to go over some trials that have to do with renal or kidney insufficiency. Can you talk about that?

Maddie Hunter:

Yeah. And so I'm Maddie Hunter and I've been living with myeloma personally for 18 years, but my dad had myeloma five years ahead of my diagnosis. So I feel like I'm up there close to Jack in terms of my number of years being in the myeloma community. I lead the Philadelphia myeloma networking group, along with Cindy. We're part of a leadership team there. And my treatment has been varied, but I've had a transplant and some RVd and permutations of that for the last 18 years. And my kidneys are impaired.

And so, when I saw that there were abstracts that had to do with renal insufficiency, they jumped right at me. Now these are not the ones that have the bows and whistles associated with them, I don't think. As you've heard from some of the other people on the panel, there have been some more glitzy kind of results. But for me, these stood out because they offer some additional learning that we're getting about how to work with people who have renal insufficiency.

And often most of the time, those of us that are insufficient renally are not eligible for clinical trials. And so our learning has to come in other ways. So one of the abstracts that I noticed was in actually an observational study. It was a study looking at a database, it's called the Connect Myeloma Registry. It's a national database to try and understand for newly diagnosed myeloma patients, could treatment actually help renal function? And in looking at this particular collection of data in this database, it was clear that if one receives is renally impaired in a mild or moderate way, and receives more than or equal to three cycles of RVd, which is our standard sort of newly diagnosed protocol, actually there is improvement in renal function.

And so that just jumped out at me because that was my experience, actually, as a newly diagnosed patient. And so this study offers those of us who have renal impairment a good conversation we can have with our physicians when there may be some reticence to use some of these agents if we're renally impaired. And there's some suggestion that many of us may benefit anyway, actually even renally, in addition to our myeloma functions.

And another abstract was very interesting to me was taking a brand new agent, one that many of us have just begun to learn about, which is called bela-maf (belantamab mafodotin). And this... Let's see if I can get this right - It's a BCMA drug conjugate. And BCMA, Jack talked about earlier, so this for the relapsed refractory, heavily treated population, is brand new, but it was used as a single agent with patients having mild or moderate renal function as part of another study called the DREAMM-2 study. It was sort of a post hoc analysis done after the DREAMM-2 study, which actually I believe is still ongoing. But for those patients who had this single agent by itself, we have concluded that bela-maf is safe and effective for people with renal impairment. So those of us that again are insufficient have perhaps, as we move forward and know more about this medication, this may be another option for us, which again, we're not going to learn necessarily from clinical trials, but from some of this observational data.

And the last abstract, which is probably the least significant of them. But I just wanted to mention that when most of us have bisphosphonate treatment to protect our bones and to prevent skeletal events, and for people with renal impairment, this is tricky. And I have not had very much bisphosphonate treatment as a result of my vulnerability, my kidneys being vulnerable, but there's a medication that has been offered up as an alternative to Zometa (Reclast), or I guess it's an ancient drug now, Aredia, which is called denosumab (Xgeva). And this is a monoclonal antibody. And this particular study, which is very small, has just begun, is being fostered by Amgen. There have just been 20 people so far involved in this, but there seems to be some leaning that Xgeva is equivalent to Zometa in terms of its efficiency or effectiveness. And it has less renal toxicity. But back to what Cindy mentioned about the risk benefit that we go through, we also go through cost benefit analyses with any medication that we take. And as we know more about Xgeva, it's another drug that is more costly, significantly, than the medications that are currently available in the bisphosphonate category. So we're going to have to look at where's the right slot for that particular medication.

But all in all, I felt like there's some good news for those of us with renal impairment. And so I, like you, Jack, have more hope.

Jack Aiello:

And it's important that if we have any kind of renal insufficiency that we always ask the doctor, are these drugs harmful to the kidneys? What's been shown in terms of their possible harm to kidneys and such, because it's not something that we want to exacerbate.

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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