[Multibilly]

Article on shifts in multiple myeloma drug treatments

by Multibilly on Mon May 18, 2015 8:18 pm

Sara Thier, "New Paradigm Emerging in Multiple Myeloma Therapy," OncLive, May 14, 2015 (full text of article)

Panel discussion moderated by Dr. Keith Stewart. Participants include Dr. James Berenson, Dr. Sundar Jagannath, Dr. Shaji Kumar, Dr. Jeffrey Zonder.

Treatments discussed include: daratumumab, elotuzumab, Farydak (panobinostat), ixazomib (MLN9708), Kyprolis (carfilzomib), Pomalyst (pomalidomide), SAR650984.

[Rneb]

Re: Article on shifts in multiple myeloma drug treatments

by Rneb on Mon May 18, 2015 8:49 pm

I read this last week.

Can you say TOTAL THERAPY ( Without the STC ?) has been re-defined....as it seems that concomitant multiple Novel drug use--is felt to be the key to long term survival.

More than a few of us, are still leery of side-effect profiles.

It's still damn good news.

[Eric Hofacket]

Re: Article on shifts in multiple myeloma drug treatments

by Eric Hofacket on Mon May 18, 2015 8:52 pm

That was a good read. Thanks for posting.

[Mister Dana]

Re: Article on shifts in multiple myeloma drug treatments

by Mister Dana on Wed May 20, 2015 10:48 pm

Thanks multibilly. Great story and I never would have seen it if not for you.

[gmarv]

Re: Article on shifts in multiple myeloma drug treatments

by gmarv on Thu May 21, 2015 3:27 pm

Thanks for posting Multibilly,

[Mike F]

Re: Article on shifts in multiple myeloma drug treatments

by Mike F on Fri May 22, 2015 5:05 pm

Nice summary of emerging treatments!

My thanks as well for the post.

[Ron Harvot]

Re: Article on shifts in multiple myeloma drug treatments

by Ron Harvot on Sat May 23, 2015 9:21 am

We are living in a era of great innovation, research and hope. The number of new drugs now available and those in the pipeline is very encouraging.

Thanks for posting this.

[DuckJibe]

Re: Article on shifts in multiple myeloma drug treatments

by DuckJibe on Sat May 23, 2015 9:49 am

I read the paper on the elotuzumab study, where in phase 2, 60 out of 73 patients dropped off the study, either for disease progression (41 patients) or other complication. 13 patients were still on study.

The overall response rate is then declared to be 80% or greater. This overall response rate must only apply to the 13 patients, otherwise it would be at best 43%, since 57% of the patients had disease progression. I must be (and hope) missing something here.

[Mark11]

Re: Article on shifts in multiple myeloma drug treatments

by Mark11 on Mon May 25, 2015 2:49 pm

Hi Duckjibe,

It is helpful for everyone if you post the link to the study you reference. It is impossible for anyone to comment on the study if you do not provide a link.

Overall response just means that a patient had some type of response. Here is a link that describes what these terms refer to and what the advantages and disadvantages are. ORR is:

"Proportion of patients with reduction in tumor burden of a predefined amount."

Disadvantage:

"Not a comprehensive measure of drug activity"

http://www.biooncology.com/clinical-trials/clinical-endpoints/advantages-limitations

Given the stats you mention it sounds like a heavily pretreated group of patients and it sounds about what I would expect. Elotuzumab has no single agent activity in myeloma and I do not think it is considered a "game changer" by many.

Overall I think the new classes of drugs listed is an unimpressive one for relapsed patients. Only DARA and SAR show minimal single agent activity and antibodies have to given IV, so patients have to go to a treatment center to get them, which negatively impacts quality of life. Hopefully SAR and/or DARA can join proteasome inhibitors, IMIDs, and high dose melphalan as anchors of a successful treatment plan for myeloma patients. At this point the others seem to only have potential as therapies that assist the mainstays like Doxil and Cytoxan do currently. I have seen little / no evidence that these therapies can provide patients with long-term, drug free remissions.

Mark

[goldmine848]

Re: Article on shifts in multiple myeloma drug treatments

by goldmine848 on Mon May 25, 2015 3:54 pm

I found the discussion and summary of available treatments to be informative. But, as I read it, I found myself thinking how difficult it will be to decide on which treatment regimen to pursue once the inevitable relapse occurs. I am guessing that there is no really scientific way to determine the optimal drug combination for me.

Equally confusing is the split in thought regarding whether to re-institute prior drug combinations that worked in the past or to use new ones because a relapse may be due to the emergence of new clones.

No easy decisions with this disease.