The 51st annual meeting of the American Society of Clinical Oncology (ASCO) started earlier to­day, May 29, and will go through June 2 in Chicago.

Approximately 30,000 physicians and re­searchers from all over the world are ex­pec­ted to attend the five-day meeting to discuss cur­rent re­search in cancer treat­ment and care.

During the meeting, there will be pre­sen­ta­tions about all types of cancer, in­clud­ing many pre­sen­ta­tions focused spe­cif­i­cally on mul­ti­ple myeloma. In fact, more than 90 myeloma-related stud­ies are scheduled to be pre­sented, in one form or another, in con­nec­tion with the ASCO meeting.

The ASCO meeting is one of three annual scientific meetings where im­por­tant new myeloma-related re­search findings are reported. The other two key conferences are the annual meetings of the American Society of He­ma­tol­ogy (ASH) and the Euro­pean He­ma­tol­ogy Asso­ci­a­tion (EHA).

As in pre­vi­ous years, The Myeloma Beacon will be cover­ing the ASCO 2015 meeting.  Readers can ex­pec­t a num­ber of articles during and after the meeting about the key myeloma findings.

An Overview Of The Meeting And Multiple Myeloma

One of the reasons ASCO’s annual meeting is held in Chicago every year is that few other U.S. cities have convention facilities large enough to host a meeting of ASCO’s size.

Yet, despite ASCO’s over­all size, the amount of myeloma-related re­search pre­sented at the meeting is usu­al­ly lower than at the somewhat smaller – but more focused – ASH meeting held each De­cem­ber.

This year is no exception.  The num­ber of myeloma-related pre­sen­ta­tions that will take place at the 2015 ASCO meeting is about one-quarter the num­ber of myeloma-related pre­sen­ta­tions at last De­cem­ber's ASH meeting.

Nevertheless, there are still a num­ber of im­por­tant myeloma-related pre­sen­ta­tions that will take place at this year’s ASCO meeting.

Potential New Myeloma Therapies

Most of the key myeloma-related pre­sen­ta­tions at the ASCO meeting will report re­search re­lated to poten­tial new myeloma ther­a­pies. Among these pre­sen­ta­tions, re­searchers are par­tic­u­larly interested in a handful that will summarize re­­sults from clin­i­cal trials testing ther­a­pies known as mono­clonal anti­bodies.

Monoclonal antibodies identify cancer cells through spe­cif­ic pro­teins on the surface of those cells. Once they have identified the cancer cells, the drugs either signal the im­mune sys­tem to attack the cancer cells, or they attack the cells themselves, or they do both (signal and attack on their own).

Taking center stage at ASCO among the mono­clonal anti­bodies being devel­oped as poten­tial new myeloma ther­a­pies will be elotuzumab and daratumumab.

Interim re­­sults from an on­go­ing Phase 3 trial will be pre­sented showing that elotuzumab, when added to Revlimid and dexa­meth­a­sone, pro­longs pro­gres­sion-free sur­vival in patients with re­lapsed/refractory mul­ti­ple myeloma (abstract #8508).

Another pre­sen­ta­tion will summarize re­­sults from a smaller Phase 2 trial looking at the ef­fi­cacy and safety of elotuzumab in com­bi­na­tion with Velcade and dexa­meth­a­sone (abstract #8573).

As for dara­tu­mu­mab, there is keen interest in the re­­sults that will be pre­sented at ASCO from an on­go­ing Phase 2 trial of the drug.  In the trial, heavily pre­treated myeloma patients have re­ceived treat­ment with "single-agent" dara­tu­mu­mab, meaning they have re­ceived dara­tu­mu­mab without any other myeloma ther­a­pies.

The pre­sen­ta­tion of the dara­tu­mu­mab Phase 2 trial re­­sults has been categorized by ASCO as a "late-breaking abstract," a desig­na­tion generally reserved for par­tic­u­larly im­por­tant stud­ies, and the abstract for the pre­sen­ta­tion is cur­rently under embargo.

Monoclonal anti­bodies are part of a broader class of cancer ther­a­pies – known as immunother­a­pies – that seek to use the body's im­mune sys­tem to fight cancer. Another pre­sen­ta­tion at ASCO that is drawing sub­stan­tial attention within the myeloma com­munity will summarize early re­­sults from a Phase 1 trial testing a novel immunother­a­py known as chi­meric an­ti­gen re­cep­tor T-cell (CAR-T) ther­a­py.

Researchers are investigating CAR-T ther­a­pies for a num­ber of dif­fer­en­t cancers. The first step in CAR-T treat­ment in­volves harvesting im­mune sys­tem cells known as T-cells from a cancer patient. The T-cells are then treated in a way that ge­net­ic­ally alters them so that, when the cells are re-infused into the same patient, they attack and kill the patient’s cancer cells.

In the Phase 1 trial of CAR-T ther­a­py in myeloma patients, re­searchers from the Uni­ver­sity of Pennsylvania are investigating the ef­fi­cacy and safety of a par­tic­u­lar CAR-T ther­a­py known as CTL019. The trial is being con­ducted in heavily pre­treated myeloma patients. The ASCO pre­sen­ta­tion about the study will report re­­sults for the first five patients treated in the trial (abstract #8517).

Results also will be pre­sented for stud­ies investigating sev­er­al new myeloma ther­a­pies under devel­op­ment for re­lapsed myeloma patients, in­clud­ing CUDC-907 (abstract #8537), evofosfamide (TH-302) (abstract #8579), MOR202 (abstract #8574), and veneto­clax (ABT-199) (abstract #8576 and abstract #8580). Most of these trials are Phase 1 stud­ies, which have as their pri­mary objectives assessing the safety of the drug and estab­lish­ing the max­i­mum tol­er­ated dose.

Existing Therapies

As one might ex­pec­t, there will be many pre­sen­ta­tions at ASCO looking at the treat­ment of mul­ti­ple myeloma with existing (already-approved) ther­a­pies. There will be, in par­tic­u­lar, a num­ber of pre­sen­ta­tions looking at stud­ies involving Kyprolis.  Of those pre­sen­ta­tions, there is par­tic­u­lar interest in one that will provide more detailed re­­sults of the so-called ENDEAVOR trial, for which initial re­­sults were reported earlier this year (see re­lated Beacon news article).

The ENDEAVOR trial is a large, head-to-head clin­i­cal trial com­par­ing high-dose Kyprolis plus dexa­meth­a­sone to standard-dose Velcade plus dexa­meth­a­sone in patients with re­lapsed myeloma. The re­­sults of that trial show that patients treated with high-dose Kyprolis and dexa­meth­a­sone had twice the pro­gres­sion-free sur­vival of patients treated with standard-dose Velcade and dexa­meth­a­sone (abstract #8509).

There also are three pre­sen­ta­tions on the ASCO agenda that will report re­­sults of stud­ies investigating Farydak (panobinostat) in dif­fer­en­t groups of mul­ti­ple myeloma patients. One of those pre­sen­ta­tions will report up­dated re­­sults of a small Phase 2 trial examining the use of Farydak in com­bi­na­tion with Revlimid and dexa­meth­a­sone in re­lapsed myeloma patients. This study is of interest because Farydak is be­lieved to work best in com­bi­na­tion with Velcade and other drugs in the pro­te­a­some in­hib­i­tor class of ther­a­pies. The re­­sults to be pre­sented at ASCO, how­ever, hint at the possibility that Farydak also may work well in com­bi­na­tion with Revlimid, and with fewer side effects than when com­bined with Velcade (abstract #8528).

Clinical Trial Updates

Also on the ASCO agenda are pre­sen­ta­tions with up­dated re­­sults from sev­er­al im­por­tant myeloma clin­i­cal trials. There will be cur­rent re­­sults, for example, from the so-called "CALGB" trial, which has been investigating the ef­fi­cacy and safety of Revlimid main­te­nance ther­a­py after single au­tol­o­gous stem cell trans­plan­ta­tion (abstract #8523).

Another pre­sen­ta­tion will provide up­dated re­­sults from the so-called FIRST trial.  The trial in­volves newly diag­nosed, trans­plant-ineligible myeloma patients, and it compares con­tin­uous Revlimid  and low-dose dexa­meth­a­sone treat­ment to two alter­na­tive ther­a­pies: fixed-duration Revlimid and low-dose dexa­meth­a­sone, and fixed duration mel­phalan, pred­ni­sone, and thalido­mide. Updated over­all sur­vival data from this trial will be pre­sented at ASCO (abstract #8524).

A third up­date will report a sec­ond­ary analysis of re­­sults from the "ASPIRE" trial, which compares Kyprolis, Revlimid, and dexa­meth­a­sone to Revlimid and dexa­meth­a­sone alone in patients with re­lapsed mul­ti­ple myeloma (abstract #8525). The re­searchers will report treat­ment out­comes by pre­vi­ous line of ther­a­py.

Chromosomal Abnormalities

In addi­tion to re­­sults re­lated to spe­cif­ic treat­ments or clin­i­cal trials, there will be sev­er­al pre­sen­ta­tions looking at the im­pact of spe­cif­ic chromosomal ab­nor­mal­i­ties on the prog­nosis of mul­ti­ple myeloma patients. One of these pre­sen­ta­tions will focus on the del(17p) chromosomal ab­nor­mal­ity (abstract #8582).  Two other pre­sen­ta­tions will examine the im­pact of the t(11;14) ab­nor­mal­ity – one in t(11;14) patients generally (abstract #8592), and another in t(11;14) patients who undergo stem cell trans­plan­ta­tion within a year of their myeloma diag­nosis (abstract #8583).

Transplant Timing & Consolidation Therapy

Finally, there will be pre­sen­ta­tions with new data re­lated to two im­por­tant topics in the treat­ment of mul­ti­ple myeloma: the timing of stem cell trans­plan­ta­tion for newly diag­nosed myeloma patients, and the role of post-transplantation con­sol­i­da­tion and/or main­te­nance ther­a­py.

One pre­sen­ta­tion, for example, will report re­­sults of a ran­domized Phase 3 trial com­par­ing two treat­ment regi­mens for newly diag­nosed myeloma patients: a regi­men that does not in­clude stem cell trans­plan­ta­tion, and a regi­men that does. The re­searchers report that the two ap­proaches are essentially equivalent in terms of sur­vival out­comes (abstract #8530).

Another pre­sen­ta­tion summarizes re­­sults of two Phase 3 trials that tested whether there is any ben­e­fit to post-transplant con­sol­i­da­tion ther­a­py with Velcade. The re­searchers find that con­sol­i­da­tion ther­a­py im­proved pro­gres­sion-free sur­vival, but did not have a noticeable effect on over­all sur­vival (abstract #8511).

Organization Of The Meeting

Research findings pre­sented at ASCO and other scientific meetings are generally com­mu­ni­cated in either oral pre­sen­ta­tions or poster summaries.

Oral pre­sen­ta­tions are usually given for re­search that is con­sidered par­tic­u­larly im­por­tant, either because the subject itself is im­por­tant, or because the re­­sults are based on sub­stan­tial amounts of evi­dence (for example, a sizable clin­i­cal trial).

Poster re­search summaries are made avail­able during spe­cif­ic “poster sessions,” when re­searchers dis­play summaries of their stud­ies on posters in a large exhibition hall.

Compared to the re­search summarized during oral pre­sen­ta­tions, the findings in poster summaries generally are in earlier stages of devel­op­ment and may in­volve only laboratory re­search or clin­i­cal trials with just a small num­ber of patients.

Abstracts for most ASCO pre­sen­ta­tions are now avail­able, and The Beacon has put to­geth­er four useful lists of all myeloma-related ASCO pre­sen­ta­tions: one list for oral pre­sen­ta­tions, a sec­ond list for poster pre­sen­ta­tions, a third for education session pre­sen­ta­tions, and a third for "eAbstracts."  The entire database of ASCO 2015 meeting abstracts also can be searched at this page at the ASCO website.

Please note that the re­­sults in some abstracts are pre­lim­i­nary and will be up­dated at the meeting.  In addi­tion, there also will be an education session at the meeting on Tuesday, June 2, about personalized ther­a­py in mul­ti­ple myeloma.