karl&myeloma

Today is Rd 2-18.

I took part in the Cure-Talk teleconference this evening. My complete notes are below and are written for people familiar with myeloma and the various treatments currently available. There are many abbreviations that I’ve not labeled because patients and care givers are familiar with these. If you have any questions, please ask.

Dr. Shaji Kumar, Mayo Clinic, and Dr. Edward Faber, U of Nebraska school of medicine.

Promising treatments over the last year and new classes of drugs.

New drugs have been making an impact, including older patients.

New Drugs. Kumar
Carfilzomid – very different side effect profile in PN.
New combinations Car/Cy, Car/Rev/Dex, Car/Thal/Dex – good benefit so far.
Pomalidomide – have treated many with Pom and side effects controlled by lowering dose. Comb of Pom/Cy, Pom/Cy/Dex, Car/Pom
MLN-708 an oral version of a drug similar to Velcade once per week. Combo Rev and Dex.
Use of older alkylating agents with the newer drugs is working in relapsed/refractory (RR).
Maintenance seems to delay relapse but is not yet known if patients live longer.

New Approaches and Classes. Faber
When relapse had to back to older drugs and now the new therapies are working for RR.
Can now keep the disease stable.
Combo Rev/Thal at MD Anderson good response in RR.
4 drug combinations with melphalin, mostly in Europe.
New – ARY-520 target is KSP. Single agent activity that is durable especially in RR.
BTK inhibitors. Block proteins that enter nucleus as tumor suppressors.
Myeloma does make a monocolonal protein.
New antibodies, 1- x. 2- deratumumab by itself had activity. Elotuzomab and Pom work synergistically. Usually well tolerated.

Questions:
Gary: How to use new drugs in first line treatment? Get into a clinical. But ask to see if available if a clinical is not available at your doctor.

Pat: Do you believe in incremental therapy or use the best now? Kumar: High risk may best with the best we get; others incrementally but control side effects. Faber: the deeper the response the better the patient does long term. Marker called cereblon for imids to work better. But hope to not exhaust best up front or sequence.

Jack: FDA may approve Pom at 4 mg even though 2 mg also worked, how to start? Both: Would probably go with the 4 mg. Get better, more durable response with steroid added.

Cynthia: In high risk patients, once myeloma gets to soft tissue, it gets aggressive, does PET/CT show this? Faber: When bone involvement happens sooner, there is usually a better prognosis. Soft tissue is more challenging especially with imids in maintenance. Can acquire DNA changes later. Kumar: Trying to understand why/when myeloma leaves bone.

A drug that worked before should be tried again after some time off. 18 months with transplant, 6 months no transplant.

Thank you, Lord Jesus, for my healing.

Amen.