TOP - ASH 2015 - Multiple Myeloma

Ali McBride provides an overview of the role of the pharmacist and the importance of working with a broad team of healthcare providers in managing patients on oral oncolytics.
R. Donald Harvey stresses the importance of patient support services in addressing financial challenges and building support communities for both patients and their families.
R. Donald Harvey believes that developing well-tolerated drugs is the key to improving the standard of care in managing patients with hematologic malignancies.
Daratumumab in combination with pomalidomide and dexamethasone is being evaluated in a 4-arm, multicenter, phase 1b study in patients with at least 2 lines of prior therapy and relapsed or relapsed and refractory multiple myeloma. Initial findings show deep and durable responses, a high response rate, and good tolerability.
Filanesib, a kinesin spindle protein inhibitor, has demonstrated promising clinical activity in patients with multiple myeloma refractory to proteasome inhibitors and immunomodulatory drugs. This new combination demonstrated good tolerability and an increased observed response rate compared with carfilzomib alone.
The elderly are an important subgroup within multiple myeloma patients, and it is important to continuously monitor MRD to help balance efficacy and toxicity of treatments. Researchers demonstrated that MRD negativity was associated with significant improved survival regardless of age or cytogenetic risk.
Researchers demonstrated that any reduction of dose intensity from 1.3 mg/m2 of bortezomib as a first-line treatment for untreated multiple myeloma patients is associated with inferior OS. Furthermore, it was suggested that the cumulative bortezomib dose be ≥20.75 mg for a better OS.
Researchers examined subset of elderly newly diagnosed myeloma patients from the GEM2010 trial and split the patients into 2 arms determined by their cytogenetic abnormalities (high risk and standard risk). Patients with 1q gains were shown to have similar outcomes to those without q1 gains when treated with bortezomib plus melphalan and prednisone, followed by lenalidomide and dexamethasone.
Modification of the current treatment regimen of RVD to “RVD-lite” provided better tolerability and enhanced clinical benefits in transplant-ineligible patients and proved to be particularly manageable in older populations, even with a wide variety of performance statuses at the beginning of the study.
Investigators propose moving to a phase 2 evaluation after using a new treatment regimen that was well-tolerated in patients with progressive disease consisting of panobinostat at 20 mg 3 times a week every other week to ixazomib at target 4 mg weekly, 3 weeks on, 1 week off, with dexamethasone 20 mg on the day of and after ixazomib.
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