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Update on Developing Myeloma Treatments

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Published on September 18, 2019

What’s the latest news in multiple myeloma care? Renowned expert Dr. Elisabet Manasanch, from The University of Texas MD Anderson Cancer Center, discusses a recent FDA approval of a first-in-class drug for the treatment of myeloma. Dr. Manasanch also provides insight to other therapies in the pipeline for myeloma and progress updates from ongoing clinical trials.Watch now to learn more from a multiple myeloma specialist.

This town hall meeting is sponsored by Janssen Biotech, Inc. and Karyopharm Therapeutics with additional support to our partner, Myeloma Crowd (MCR), from Takeda Oncology and Foundation Medicine. These organizations have no editorial control, and Patient Power is solely responsible for the content. It is produced by Patient Power in partnership with The University of Texas MD Anderson Cancer Center.

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Transcript |

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.

Dr. Manasanch:         

Well, there are a lot of things coming out of new therapies that we actually got some data for the first time at the annual meeting of the American Society of Clinical Oncology, which was in June. So, we actually got for patients who have relapsed refractory myeloma, there are a lot of new therapies. One of those therapies is called iberdomide. It’s a new immunomodulatory drug.

So, it follows in the steps of thalidomide (Thalomid), lenalidomide (Revlimid), pomalidomide (Pomalyst) and now, iberdomide. It seems to have activity in patients that no longer have response to immunomodulatory medications, including thalidomide. So, this is some promising medication that is certainly gonna need more clinical trials. That’s something that patients can look forward to if they have the need for those medications at this time.

Additionally, there’s been another approval from the FDA based on an isolated program for a medication called selinexor (Xpovio), which is a tablet that is taken basically a few times a week and that’s taken with dexamethasone. That’s what the approval for. So, this medication called selinexor with dexamethasone is also a new class of medication.

So, it’s not a proteasome inhibitor or an immunomodulatory drug. It works through basically getting some of the proteins that work in sterilizing the neutrons of the cell. So, you can get that medication also through your doctor that’s approved. So, if you don’t have a lot of treatment therapy, that’s something that you can do.

Of course, there’s also other medication called BiTE, the biospecifc T-cell engager. Those are antibodies. These antibodies are in clinical trials and we also have some clinical data for the first time in the past few months showing that they’re also responsive in patients that don’t have a lot of other good treatment options.

So, if you’re one of those patients, you can go for either iberdomide off clinical trials, selinexor that you could get just with a doctor in the community or off a clinical trial. Then there’s this BiTE medication, which are also in clinical trial and are ongoing.

Of course, there is also all the clinical trials with CAR-T cell therapies. One of the new things is that there’s going to be soon a study opening that has what we call off-the-shelf CAR T, which means they use T cells. These are white cells from other people. They’re not your own T cells.

So, they can manufacture those cells very quickly and I think most patients know already about CAR-T cell therapy but that’s some of the new things that are coming in that phase. On top of that, there are still ongoing studies with CAR-T cell therapies.

Additionally, there’s been a new CD38 antibody. It’s called isatuximab that has shown in a randomized study with thalidomide and dexamethasone that there is basically the time that patients don’t relapse increased. So, there’s a new CD38 antibody that is not daratumamab (Darzalex) that is probably maybe approved by the FDA later this year or next year. So, that’s another CD38 antibody that is probably gonna be available soon, again, off clinical trials.

Another important thing – there are some clinical trials ongoing for newly diagnosed myeloma. Most of these studies, what they’re doing is they put a proteasome inhibitor with an immunomodulatory drug with dexamethasone (Decadron), and then they add an antibody. So, they do a lot of studies comparing the addition of these antibody with the usual backbone of myeloma therapies for newly diagnosed patients.

So, those studies are ongoing. If you have newly diagnosed myeloma, that’s something that you can participate in. So far, the initial report shows that there seems to be more efficacy if you do the four drugs versus the three drugs, which is what we’ve traditionally been doing. 

And then if you have a smoldering myeloma, there’s a lot of evidence – right now, there are a few randomized studies, all of them showing that if you do treatment a little bit earlier on that there seems to be a delay in the onset of multiple myeloma.

However, we have not yet agreed on what is the best therapy to give and there are right now, for example, there are studies ongoing, probably there’s gonna be another study for patients with using antibodies. 

There’s one right now ongoing, daratumamab versus observation, which patients can enroll into and there’s another one probably also with daratumamab with lenalidomide-dexamethasone. There might be another one also, maybe isatuximab with lenalidomide-dexamethasone.

So, those patients that have smoldering myeloma, even off clinical trial, we’re not certain, we don’t have a formal recommendation, they can go on clinical trials for that. It seems that just doing treatment early does impact the disease in a favorable way.

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.