Yesterday was the fourth day of the American Society of Clinical Oncology (ASCO) annual meeting in Chicago. Although today is the final day of the meeting, the multiple myeloma-related sessions concluded yesterday.

The day began with a meeting-wide session to review the highlights of the previous day across all cancer types. There were six presentations, and despite all of the types of cancers being discussed at the meeting, an entire presentation was devoted to myeloma.

Dr. Jean-Luc Harousseau from the Rene Gauducheau Cancer Center in France presented the myeloma highlights. He described several of the studies that The Beacon has summarized in our ASCO updates, with particular emphasis on studies involving autologous stem cell transplants in the era of novel agents, supportive care, and newer agents under development.

There were also two poster sessions, one in the morning and one in the afternoon, that had just a few myeloma-related posters.

The morning’s poster session was about “Trials in Progress.” The session—a first for ASCO—was designed to facilitate awareness of open, ongoing clinical trials. Two ongoing myeloma research studies were featured.

The first poster highlighted a large Phase 2 study designed to see if lower dose, once weekly Velcade (bortezomib) treatments in combination with dexamethasone (Decadron) can be as effective as standard twice-weekly dosing.

The second involved another Phase 2 study, this one combining Velcade with panobinostat (Farydak) and dexamethasone in relapsed/refractory multiple myeloma patients. The goal of the study is to see if adding panobinostat can help overcome Velcade resistance.

Both studies are a long way from complete. As a matter of fact, the panobinostat study is still recruiting patients. The study is facing the challenge of finding enough patients who recently became resistant to Velcade.

The afternoon’s poster session was about “Patient and Survivor Care.” Both of the myeloma posters in this session compared Prolia (denosumab) to Zometa (zoledronic acid) for the treatment of bone disease related to myeloma as well as other advanced cancers.

The first poster presented results from a Phase 3 study that showed Prolia delayed the time until the first fracture and also reduced the number of fractures that the patients experienced compared to treatment with Zometa. The researchers suggested that Prolia is more potent than Zometa and are testing it in prostate and breast cancer to see if it has anti-cancer activity.

Among the typical safety concerns related to bone disease treatments, Prolia did not cause kidney problems because it is not cleared from the body by the kidneys. Prolia caused a higher rate of high calcium levels in the blood, which the researchers attributed to Prolia’s greater efficacy. Finally, both treatments had similar rates of osteonecrosis of the jaw.

The second study showed that Prolia was more effective than Zometa at reducing bone disease-related pain.

The afternoon’s information-packed session, “Complications of Myeloma and Myeloma Therapy,” focused on minimizing drug-related side effects in multiple myeloma patients.

Dr. Todd Zimmerman of the University of Chicago spoke about the complication deep vein thrombosis (a blood clot in a deep vein) in multiple myeloma patients. He explained that myeloma puts patients at an increased risk of developing blood clots.

Treatment for multiple myeloma, in particular treatment with high-dose dexamethasone or other multi-agent therapies, can significantly increase the risk of blood clots. Dr. Zimmerman recommended that aspirin, warfarin (Coumadin), or low-molecular weight heparin be used to minimize the risk of clotting.

Next, Dr. Paul Richardson of the Dana-Farber Cancer Institute reviewed the latest studies involving peripheral neuropathy (PN).

Just like with deep vein thrombosis, myeloma can also cause PN and treatment further increases the risk. Thalidomide and Velcade often cause PN. Additionally, myeloma patients with Vitamin B-12 deficiencies are at even higher risk of developing PN.

Because thalidomide-induced PN is often irreversible, Dr. Richardson recommended discontinuation of thalidomide at the first sign of neuropathy. Velcade-induced PN, on the other hand, is often reversible, so Dr. Richardson recommended managing PN by reducing the dose and frequency of Velcade.

Dr. Richardson also recommended a list of vitamins and supplements as well as cocoa butter massages to help reduce PN.

The final speaker, Dr. David Roodman of the University of Pittsburgh, concentrated on the use of bisphosphonates to help improve patient bone health. This is important, since a majority of multiple myeloma patients suffer from bone damage.

ASCO and Mayo Clinic guidelines currently call for two years of monthly intravenous therapy using Aredia (pamidronate) or Zometa. Only patients with active bone disease should continue treatment longer.

Both Aredia and Zometa decrease the risk of a fracture by an average of almost 50 percent, and these bisphosphonates also help slow further bone deterioration. However, the use of bisphosphonates is not without risk, such as kidney damage and osteonecrosis of the jaw.

Dr. Roodman highlighted that a new, experimental drug, Prolia, looks promising for the management of myeloma-related bone disease.

In the question and answer period following the formal presentations, one attendee asked about why constipation was so common among patients taking thalidomide. Dr. Zimmerman’s answer: Neuropathy.

The questioner then asked about another common side effect caused by thalidomide: patient confusion and disorientation. Dr. Richardson felt that was a result of the drug getting past the blood-brain barrier. He stressed patients should immediately be taken off the drug if this occurs.