The Latest Myeloma News from the American Society of Hematology Meeting

Andrew Schorr:

We're going to start with Dr. Durie for a minute, and Dr. Durie, as with each of you, I'm going to ask you gentlemen a couple of key questions. So, first of all, how big a deal was the data presented at ASH today for people living with multiple myeloma who are either looking to start treatment, in treatment, may need a transplant? I know the data came from around the world, a lot of it from Europe. Also, one of the questions would be evaluating do you simply; you all have these terms, very good, partial remission, VGPR, PR, and CR, complete remission; and get your perspective on what's important, and maybe we'll even have a debate about that.

Dr. Durie, first of all, overall how big a deal was this meeting as far as people living with multiple myeloma and what drug therapies might be available or transplant for them?

Dr. Durie:

Andrew, I think that this was perhaps the most positive ASH of all times for myeloma patients. We saw for the first time the three main novel agents; Velcade, Revlimid, and thalidomide; which have been used in relapsed settings moving into the front line. As you mentioned, there were phase-III trials looking at different combinations of these three novel agents in the front line setting. I would say that perhaps the greatest enthusiasm was for a trial called the VISTA trial, which was comparing the combination of Velcade with melphalan and prednisone to melphalan and prednisone alone, and it has been quite remarkable to see the synergy, the added benefit, of combining the Velcade with the standard melphalan/prednisone regimen. The results of this trial showed remarkable responses up front as well as continued benefit out through the first couple of years of this trial.

So, the synergy, the added benefit of combinations, was a key feature of this meeting. We saw also the combination of Velcade with a variety of other agents. You mentioned the role of stem cells for patients looking to do stem cell, and this is clearly still a standard of care for transplant-eligible patients. An important trial was from France comparing Velcade/dex with VAD as front line therapy, and the remarkable thing in this trial was that patients taking Velcade/dex as the first strategy only 30% of them needed to go ahead with a second transplant, which is the normal standard in the French trials. But other combinations were also exciting with Velcade. Velcade combined with thalidomide and dex compared with thalidomide/dex alone from the Italian group with Michele Cavo, M.D., very strong results with the Velcade/thalidomide/dex combo, and then Paul Richardson, M.D., presented Velcade/Revlimid/dex, and our own group that I'm involved with based in Los Angeles with Aptium Oncology; we presented Velcade, Cytoxan, and dex. So very, very strong data with Velcade combinations in the front line setting.

And then obviously another area of interest and excitement for follow-up was to look at the Revlimid and dex combinations front line, the follow-up of the ECOG trial, Revlimid/low-dose dex versus Revlimid/high-dose dex was presented by Vincent Rajkumar, M.D., and for the Southwest Oncology Group a very important trial, Revlimid/high-dose dex versus high-dose dex alone was presented by Jeff Zonder. So all of these bits of information are very important, but I think also a lot of numbers, and it's going to take everyone a bit of time to sort through well what does this mean for me and a very important time to think and discuss the options for patients under age 65 who might be eligible for transplant versus those in an older group who might be looking for the best regimen to control their disease chronically long term. So, perhaps I'll stop there.

Andrew Schorr:

I was just going to comment as sort of the reporter on the scene, and just say clearly folks, I saw the myeloma experts excited, and they have more going on than every before, but it does take this time. If you're not seeing one of the folks with us today or another myeloma super subspecialist, it may be that for your community oncologist there is a time when all this sorts out, and if they're going to be changing what they do when, you know, that takes an active discussion with them and them maybe even listening to a program like this or one specifically for physicians. You can play a role as a proactive patient saying, 'What about this that was presented at ASH? I don't claim to know all the letters and numbers, but what does that mean for me?'

Let's go on to Dr. Jim Berenson, also in Los Angeles. Dr. Berenson, am I right? It was an exciting meeting at myeloma, and is there something to be done differently now in your opinion?

Dr. Berenson:

Yes, I think it was a very exciting meeting. I think we really corroborated a lot of preclinical work that we and others had done to demonstrate the synergy of bortezomib or Velcade with a variety of chemotherapeutic agents, and now even synergy with a now-approved Velcade with drugs that aren't even approved yet, the histone deacetylase inhibitors, the heat shock protein inhibitors, and a variety of new agents that are now being looked at with what we now consider a good old standard almost, Velcade, and I think what we view myeloma now is as more of a chronic disease and more of a marathon and a sprint, so I think in terms of these combinations, the real beauty is that Velcade can be a platform for a variety of drugs. For example, Brian mention Cytoxan, which we have had very good luck with as well in combination with Velcade even among people who failed melphalan and Velcade, and several years ago one would have never dreamed that a drug that's as similar in activity and mechanism as Cytoxan to melphalan would work in a melphalan/Velcade failure. The recent approval of Doxil and Velcade. We in our own group are using a combination of Doxil, Velcade, and very low-dose Decadron, very active, and I think that's the true excitement right now is that these drugs can be given long term with good safety and really importantly in my clinic, good quality of life for the patient, much different than we've observed in the past with more intensive therapy than drugs that were fraught with lots of quality of life issues.

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Page last updated on November 22, 2013