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Treatment Strategies for Relapsed Myeloma

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Published on April 8, 2020

Key Takeaways

When a myeloma patient relapses, it can be a scary time as you and your doctor work together to figure out the next course of action. Is there any encouraging data on new treatment options? We posed this question to a panel of myeloma experts, including Dr. Faith Davies, Dr. Larry Anderson and Dr. Nina Shah, at a recent medical conference. 

Tune in to hear their perspectives on treatment strategies, clinical trials and second stem cell transplants. Their message is one of hope, with more options coming.

This program is sponsored by GSK and Karyopharm. These organizations have no editorial control. It is produced by Patient Power. Patient Power is solely responsible for program content.

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Transcript | Treatment Strategies for Relapsed Myeloma

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.

Jenny Ahlstrom:                           

Hello, my name is Jenny Ahlstrom, and I’m the founder of Myeloma Crowd, and welcome to Patient Power. Today we have with us three myeloma experts at the ASH Hematology 2019 meeting. And we’re really thrilled to have them with us and talk about all the amazing advances that are happening. So, thank you, doctors, for coming.

We have with us Dr. Faith Davies from NYU, we have Dr. Larry Anderson from UT Southwestern, and we have Dr. Nina Shah from University of California in San Francisco, UCSF, and there’s so much to talk about.

Dr. Davies:                    

So I think at this year’s meeting there have been some really great abstracts about selinexor (Xpovio) showing that in the relapsed and refractory setting that it is able to produce good responses and that you can combine it with other drugs such as pomalidomide (Pomalyst). And that’s a nice oral combination for patients, so I think that’s really good.

There are also some very, very encouraging data about venetoclax (Venclexta). Venetoclax has had a little bit of a bumpy ride, and the researchers have gone back and looked at all the data and presented much of it here, and have really shown that if myeloma patients have a particular myeloma chromosomal abnormality, the t(11;14), that the venetoclax seems to be extremely effective in that group. 

But also, in another group of patients that have one of the proteins that controls myeloma and cell death, if one of those proteins is very high, called Bcl-2, those patients seem to benefit from it as well. And so, I think that the hope moving forward if we can really identify which patients benefit the most from it, that we can not only get the best response rates and the best duration of response, but we can also hopefully minimize the side effects. Those two drugs have actually been very prominent at this meeting, and I think they’re both drugs which may be a little more accessible to patients today, rather than talking about things that are in clinical trials or a little bit further away. 

Jenny Ahlstrom:                          

Any other thoughts on strategies for relapsed that people should consider? We attended one session that was talking about, "What do you do for relapsed/refractory myeloma? "And it was almost like, "Well ,you should do a clinical trial." Like we’re still combining, and we’re still trying to optimize the combinations.

Dr. Anderson:               

I think that’s key, is just if you don’t have access to a clinical trial, optimizing your combinations. A lot of times, we’ll end up doing four drugs that are combined in these patients that have failed everything. And then we can still get responses to these drugs in combinations that they had failed separately before. So that’s key to remember.

And sometimes a year or more of remissions from just adding cyclophosphamide (Cytoxan) for example, to your antibody and -imid combo, things like that can really get you some mileage to get you along further until one of the trials opens up.

Dr. Shah:                      

I know this might be also controversial, but I’ve also done second transplants, because sometimes people have had a couple years of duration. And I’m a person that loves it when a patient doesn’t have to come back to see me as frequently, for example, for serial infusions or whatever. And it’s kind of a nice way to get people into remission—understanding that it’s not going to be as long as the first one. And they can go on maintenance therapy and sort of go back to life a little bit. So that’s not a bad option, and that’s why we try to collect enough stem cells up front to do that.

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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