ASCO 2010 Multiple Myeloma Update - Day One

Friday, June 4, was the first day of this year's American Society of Clinical Oncology (ASCO) annual meeting in Chicago. Most of the big multiple myeloma news of the day came out of a poster session in the afternoon.
At "poster sessions," researchers present a poster-sized summary of their research in a small, 2 meter by 1 meter cubicle. Researchers and physicians mill about, taking pictures of the posters with their cell phone cameras or taking notes. Sometimes one or more of the contributing researchers are present to answer questions. More often than not, however, there is nothing there but a mounted poster.
After a few hours, a poster discussion session is held in a large meeting room. About 400 people attended yesterday's session, which covered posters related to multiple myeloma, lymphoma, and other hematologic cancers. The session was hosted by Dr. Nancy Bartlett of Washington University in St. Louis, and Dr. Robert Z. Orlowski of the MD Anderson Cancer Center in Houston.
Dr. Orlowski commented on a number of the myeloma-related posters. This was helpful, since it is hard to interpret results from early drug studies like these.
One study Dr. Orlowski commented on was a dose-escalation study of carfilzomib plus Revlimid (lenalidomide) and low-dose dexamethasone in relapsed/refractory multiple myeloma. Even though it might seem hard to get excited about such early results, Dr. Orlowski said "this combo looks attractive," and he sees real potential in this early research. (The Beacon covered this study in detail in an article published last night.)
A second poster Dr. Orlowski reviewed concerned the results of a Phase 1b clinical trial of oral panobinostat (Farydak, LBH589) in combination with Revlimid and dexamethasone. Once again, the patients in this study had relapsed or refractory multiple myeloma. Dr. Orlowski was not as positive about the results of this study. The reason: "Too many adverse side effects," most likely caused by the high doses of dexamethasone.
In a follow-up interview, a representative from Novartis, the company developing panobinostat, elaborated on the side effects observed during the study. She explained that "Europeans still use high dose dexamethasone as the standard of care [and] in order to get the study approved, we needed to incorporate high dose dexamethasone in the study." Unfortunately, "high dose dexamethasone can be highly toxic and can cause many unwanted side effects."
A third study, which looked at results of a Phase 1 trial of Zolinza (vorinostat) combined with Revlimid and dexamethasone in relapsed or refractory multiple myeloma patients, got a better review from Dr. Orlowski. He called the study "promising." Zolinza is a drug similar to panobinostat, and is already approved by the U.S. Food and Drug Administration as a treatment for cutaneous T-cell lymphoma.
Another drug from Novartis was the subject of a fourth poster reviewed by Dr. Orlowski. The drug has the codename RAD001, but the active ingredient in the drug -- everolimus -- is the same as in the drugs Zortress and Afinitor, which Novartis already markets to prevent kidney transplant rejection (Zortress) and to treat kidney cancer (Afinitor). RAD001 was tested in combination with Revlimid in relapsed or refractory myeloma patients. Dr. Orlowski described the results as "mixed," given the neutropenia and peripheral neuropathy observed in the trial participants.
The last poster discussed by Dr. Orlowski was a University of Arkansas for Medical Sciences study comparing outcomes of the Total Therapy 3 and Total Therapy 2 regimens. The study's objective was to isolate specific genes that might determine which combinations of novel therapy agents work best in specific patients. Dr. Orlowski's take on the results of the study were that adding Velcade (bortezomib) to most anti-myeloma drug combinations helped some high risk patients in the study. Most other combinations have little or no impact.
Dr. Orlowski concluded the multiple myeloma-related portion of the poster discussion session this way: "Can we personalize myeloma therapy yet?" Dr. Orlowski answered his own question: "No." But adding Velcade may help until we can identify which patients will respond best to which drug combinations.
Note: For an early look at the highlights from Day Two of the ASCO 2010 meeting, see this posting thread in the Myeloma Beacon forums.
Related Articles:
- ASCO 2018 Update – Expert Perspectives On The Key Multiple Myeloma-Related Oral Presentations
- Nelfinavir Shows Only Limited Success In Overcoming Revlimid Resistance In Multiple Myeloma Patients
- Nelfinavir-Velcade Combination Very Active In Advanced, Velcade-Resistant Multiple Myeloma
- Adding Clarithromycin To Velcade-Based Myeloma Treatment Regimen Fails To Increase Efficacy While Markedly Increasing Side Effects
- Once-Weekly High-Dose Kyprolis Yields Deeper Responses And Longer Remissions Than Twice-Weekly Kyprolis (ASCO & EHA 2018)