December 12, 2017
Before presenting my ASH summary, I’ll mention a late-breaking abstract presentation that I attended early this morning focused on a Phase 3 trial using Darazalex (daratumumab)in frontline therapy (remember at this time, Dara is only approved in the relapse setting). Dr. Maria V Mateos presented the ALCYONE trial comparing Velcade, melphalan, and prednisone (VMP) +/- Dara. You might ask why VMP instead of RVd but this is European study which has different access to drugs. That said, the Dara arm certainly produced better results for n=706 patients: ORR (91 vs 74%, CR 43 vs 24%), MRD- (22 vs 6% where MRD used NGS 10-5). PFS has not yet been reached for the Dara arm vs 18 mos so Dara may well get approved for induction therapy, and could especially benefit non-transplant eligible patients.
Here’s my preliminary summary of ASH 2017, and I emphasize “preliminary” because I’ll be learning more about the interpretation ASH 2017 results as I listen to follow-up presentations by multiple myeloma expert oncologists over the next 1-2 months.
The most exciting presentation for me was the new BCMA mAb drug conjugate from Glaxo Smith Kline that resulted in 60% ORR for RRMM patients. Besides this presentation, I didn’t see much on new results for venetoclax, selinexor, isatuximab, or others.
CAR-T therapy programs were presented, but the numbers are still small.
I appreciated that 2 QOL presentations showed 1) Multiple myeloma patients would benefit from the high-dose flu vaccine plus a booster, rather than the standard of care and 2) Prophylactic use of 12 weeks levofloxacin while undergoing treatment reduced fevers and deaths without increasing infections.
There was considerable focus on high-risk smoldering multiple myeloma (HRSMM) patients, and it will be interesting to see if early treatment of just Dara or the intense CESAR protocol or something else will be best to delay the onset of MM (and maybe be curative for some?).
MRD was on everybody’s lips and trial results but it’s still frustrating that there isn’t an agreed-upon standard. Maybe it doesn’t matter if we use NGF or NGS but sensitivity does matter and it appears that 10-6 should be the standard along with using PET-CT.
Transplants are still a very active subject for trials and still should be kept in our bag of potential treatment tools.
I’ll be putting together a detailed summary of ASH17 and posting it on our support group website www.sfbayareamyelomasupport.org under Articles, where you’ll find previous conference reports as well. In the meantime, the best recommendation I can make is for you to stay educated and consider participation in clinical trials because that how myeloma treatments are advanced. Wishing all of you the best of success and glorious holidays.
