Day 2: A busy day at ASH
December 10, 2017
Today I attended oral presentations from 8 a.m. to 6 p.m. with a few short breaks but not even enough time to check out posters. Let me discuss several findings from several oral presentations (#abstract).
Dr. Aaron Rosenberg studied Second Primary Malignancies (SPMs) in multiple myeloma patients with and without an stem cell transplant (SCT) and concluded the risks of developing an SPM was similar for both 5-yr (4.8% vs 4.7%) and 10-yr (9.1% vs 7.5%) analysis. (#332)
Dr. Michele Cavo discussed the EMN02/HO95 trial which compared 3 arms MP, SCT, Tandem SCT after induction. In particular the SCT arms showed significant 3-yr OS benefit over VMP (70-75% vs 45%). In addition 2 SCT’s were better than a single SCT when examining 3-year PFS (72% vs 64%) and OS (89% vs 82%). When asked about why the STAMINA trial with similar consolidation, 1 SCT or 2 SCT’s arms showed no real difference, the answer was that there were significant trial scheme differences in the induction used (drugs and cycles). (#397, #401)
Dr. Herve Avet-Loiseau examined MRD for the IFM2009 trial (RVD +/- SCT -> Consol, ->Maint. He concluded that MRD should be considered as a surrogate biomarker if 10 superscript -6 sensitivity is used but that “it’s probably still important to include PET-CT”. MRD- patients did well on both arms. (#435)
Smoldering Multiple Myeloma (SMM)
Dr. Maria V. Mateos provided preliminary results for GEM-CESAR trial for HR SMM pts: KRd followed by SCT, followed by KRd Consolidation and Rd Maintenance. The Primary Objective for this trial is MRD. Both MRD- and ORR improved after Induction (31%, 71%), SCT (50%, 100%, Consolidation (60%, 100%) and Maintenance (NA, 100%) and while OS is encouraging, it’s much too early to say if this is curative for some SMM patients. (#402)
Dr. Craig Hofmeister described Dara monotherapy for HR SMM pts for long, intermediate and short durations among n=123 pts. Longest duration was best (56% ORR and 95% 1 yr PFS) and will likely result in a Ph3 study. (#510)
Dr. Attaphol Pawarode showed results from a Ph2 study of Pembrolizumab (checkpoint inhibitor) combined with low-dose Rev maintenance after an SCT. However, since the FDA stopped the trial early, only 29 patients (rather than 46 patients) were accrued. OS at 18 months is 100%. So while numbers look good, it’s unclear how much Pembro added to the benefit of getting Rev maintenance. (#339)
Dr. Adam Cohen provided results of varying dosages of BCMA CAR-T +/- Cytoxin for 24 pts across 3 arms. Cytokines Release Syndrome (CRS) was experienced by 20 pts and there was 1 death. 11of 24 pts (10 of 19 in the 2 preferred arms) showed responses and interestingly BCMA expression amount did not correlate with responses. The longest survivor so far is at 24 months. (#505)
Dr. Fu (from China) described a pilot study giving 10 patients both BCMA-CART and CD19-CART infusions. CRS typically came on at about 14 hrs and lasted 3 days but none had to go to the ICU. And 9 of 10 have shown responses. (#506)
Dr. Emily Meier indicated the rate of multiple myeloma patients using hospice has doubled between 2000 and 2013, with a high percentage enrolling within 3 days of death, although the median length of hospice is 13 days. (#346)
Dr. Sonja Zweegman compared Td +/- Ixazomib (Ninlaro) induction therapy and showed ORR benefit for all patients, HR pts, Fit/Unfit/Frail pts although 54 of 120 pts discontinued treatment including 60% of frail patients (often due to Thalidomide). (#433)
Dr. Krina Patel examined Ixazomib-Rev maintenance, showing 100% ORR (34% CR) and 2 yr PFS of 81%. However, 8 of 16 High-risk MM pts have progressed. (#437)
Dr. Andrew Branagan showed that 2 doses (45 days apart) of high-dose flu shots offer twice the immune protection compared to the single standard-of-care flu shot. (#438)
On that note, it’s been a long day with the last full day of ASH tomorrow. Tomorrow (Mon 12/11) evening 8 p.m. ET you should tune into watch Drs. Durie, Richardson and Mikhael discuss key ASH presentations. I’ll be watching.
Wishing you the best of health!