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Dr. Armitage presents a case and asks Dr. Holstein to comment about her approach to treatment. The patient is be a 59-year-old man who had presented with symptomatic myeloma with bone pain and he was feeling unwell. He had bone lesions on images. He was anemic. This all happened 2 years ago. He was treated with RVD for six cycles and then an auto-transplant, followed by lenalidomide maintenance. Now, 2 years later, the patient returned to report that he had started to not feel well. He was found to have a falling hemoglobin level and a bone marrow biopsy showed 50% plasma cells. Repeat bone imaging showed new lytic lesions. How would you treat this patient?
In this episode, Dr. Armitage presents a case and asks Dr. Holstein to comment on her approach to treatment of this individual. The patient is a 65-year-old man who was referred because of a monoclonal protein found in his blood. The patient was asymptomatic. He had a normal exam. He had an IgG kappa protein of about 3.5 g. There was no protein in the urine and the bone marrow biopsy showed 17% clonal plasma cells. His renal function calcium, bone images were all normal. The patient had been told by another physician that no treatment was appropriate and he came to you wanting another opinion.
On March 2, the U.S. Food and Drug Administration (FDA) approved isatuximab-irfc (Sarclisa) in combination with pomalidomide and dexamethasone for the treatment of adult patients with multiple myeloma who have received at least two prior therapies, including lenalidomide and a proteasome inhibitor. ...
Studies have shown that all patients diagnosed with multiple myeloma had a preceding asymptomatic expansion of clonal plasma cells, clinically recognized as monoclonal gammopathy of undetermined significance or smoldering multiple myeloma. According to C. Ola Landgren, MD, PhD, Professor of...
Suzanne Lentzsch, MD, PhD, Professor of Medicine and Director of the Multiple Myeloma and Amyloidosis Service at Columbia University, offered her thoughts on venetoclax-based regimens, such as the one described by Dr. Kaufman. “Despite tremendous progress in the treatment of multiple myeloma, the...
In a phase I/II study of patients with advanced multiple myeloma and t(11;14) translocations, the combination of venetoclax and dexamethasone showed strong, durable activity, even in patients refractory to daratumumab, study investigators reported at the 2019 American Society of Hematology (ASH)...
The ASH 2019 Annual Meeting & Exposition featured countless important sessions and lectures. It would be impossible to attend all the symposia, oral presentations, poster presentations, and special events. Below, we have selected some presentation highlights to supplement our coverage of the...
Thierry Facon, MD, of Lille University Hospital in France, and Michael Jain, MD, PhD, of Moffitt Cancer Center, Tampa, were interviewed by The ASCO Post on the second-generation chimeric antigen receptor (CAR) T-cell products for treating multiple myeloma. According to Dr. Facon, essentially...
Two novel dual-target chimeric antigen receptor (CAR) T-cell strategies are yielding early and durable responses for patients with relapsed or refractory multiple myeloma, as well as potentially less cytokine-release syndrome and neurotoxicity compared with first-generation CAR T-cell products,...
More than 25,000 specialists in hematology from over 115 countries attended the 61st American Society of Hematology (ASH) Annual Meeting & Exposition held last December in Orlando. The conference featured a stunning array of 4,900 abstracts with impressive new data in the treatment of multiple...
In a phase I study reported in the Journal of Clinical Oncology, Max S. Topp, MD, and colleagues found the maximum tolerated dose of the investigational anti–B cell maturation antigen (BCMA) bispecific T-cell engager (BiTE) molecule AMG 420 elicited a high response rate in patients with relapsed or ...
Over the past week, the U.S. Food and Drug Administration (FDA) granted Priority Review to treatments for multiple myeloma and prostate cancer; gave Fast Track designation to a targeted gene therapy for lung cancer; granted Orphan Drug designation to a combination therapy for hepatocellular...
This week, the U.S. Food and Drug Administration (FDA) granted Priority Review to treatments for ovarian, prostate, and lung cancer; granted Orphan Drug designation to therapies for chemotherapy-induced thrombocytopenia and multiple myeloma; and granted Breakthrough Device designation to platforms...
To complement The ASCO Post’s comprehensive coverage of the 2019 American Society of Hematology (ASH) Annual Meeting & Exposition, here are several abstracts selected from the meeting proceedings focusing on novel therapeutic regimens including the monoclonal antibody daratumumab in combination ...
In the phase II DREAMM-2 trial reported in The Lancet Oncology, Sagar Lonial, MD, and colleagues found that the antibody-drug conjugate belantamab mafodotin was active in patients with heavily pretreated relapsed or refractory multiple myeloma. The agent is a conjugate of an anti–B-cell maturation...
As reported in The Lancet by Maria-Victoria Mateos, MD, and colleagues, interim analysis of overall survival in the phase III ALCYONE trial has shown a significant benefit of the addition of daratumumab to bortezomib, melphalan, and prednisone (D-VMP) in patients with newly diagnosed multiple...
Multiple myeloma is a malignancy characterized by clonal proliferation of terminally differentiated plasma cells within the bone marrow. Although it leads to a host of different issues within the body, overall survival has steadily improved in recent years. “This is largely because of better...
A year before my diagnosis of multiple myeloma, in 2010, my husband Paul and I moved with our six children to Monterrey, Mexico, where Paul was helping to create a venture capital industry. We were so busy settling into a new country and getting our children integrated into school that when I...
Emerging treatments for relapsed or refractory multiple myeloma include options beyond triplet regimens, including immunotherapy and mutation-driven therapy. Several exciting drugs are poised to be available in the clinic in 2020, according to speakers at the recent JADPRO Live, the annual...
In patients with relapsed or refractory multiple myeloma, two novel dual-target chimeric antigen receptor (CAR) T-cell strategies are yielding early and durable responses, with seemingly less cytokine-release syndrome and neurotoxicity than first-generation CAR T-cell products, according to the...
In a study reported in the Journal of Clinical Oncology, Paiva et al examined the applicability of International Myeloma Working Group (IMWG) criteria for next-generation flow cytometry assessment of minimal residual disease (MRD) in multiple myeloma. They found that the IMWG flow MRD-negative...
Saad Z. Usmani, MD, of the Levine Cancer Institute, discusses phase III study findings suggesting that the combination of carfilzomib/dexamethasone/daratumumab represents an efficacious new regimen for patients with relapsed or refractory disease, including those refractory to lenalidomide (Abstract LBA-6).
C. Ola Landgren, MD, PhD, of Memorial Sloan Kettering Cancer Center, discusses phase II study findings that showed an 83% negative rate of minimal residual disease in newly diagnosed multiple myeloma treated weekly with 8 cycles of the quadruplet regimen of carfilzomib/lenalidomide/dexamethasone/daratumumab, without autologous stem cell transplant (Abstract 862).
Mark Bustoros, MD, of Dana-Farber Cancer Institute, discusses phase II study results showing that the combination of ixazomib, lenalidomide, and dexamethasone is effective in patients with high-risk smoldering disease, with a high response rate, convenient schedule, and manageable toxicity. Longer follow-up for disease outcome is ongoing (Abstract 580).
For the country, and for me personally, 2001 was a watershed year. In May, my mother died; the following month my brother, Dom, then 57, called to tell me he had just been diagnosed with multiple myeloma. Except for some fatigue Dom had complained about at our mother’s funeral, there were no...
In patients with relapsed or refractory multiple myeloma, the addition of daratumumab to carfilzomib plus dexamethasone improved multiple outcomes, compared with carfilzomib/dexamethasone alone, in the international phase III CANDOR trial.1 “Overall, carfilzomib/dexamethasone/daratumumab was...
Edward A. Stadtmauer, MD, of the University of Pennsylvania Abramson Cancer Center, discusses phase I results of immune cells, modified with CRISPR/Cas9 technology, and infused in three patients (two with multiple myeloma and one with sarcoma). Researchers observed the cells expand and bind to their tumor targets with no serious side effects (Abstract 49).
Even though autologous hematopoietic stem cell transplantation (AHCT) is an effective treatment for multiple myeloma, only 4 out of 10 patients receive this therapy. A new study presented by Munshi et al at the 2019 American Society of Hematology (ASH) Annual Meeting & Exposition (Abstract 782) ...
More than three out of four patients with relapsed multiple myeloma, or myeloma that was refractory to at least two therapies, remained in remission 7 months after treatment with a novel chimeric antigen receptor (CAR) T-cell therapy targeting two proteins that are frequently found on myeloma...
Patients with multiple myeloma who had received a median of five prior therapies with refractory disease had a high response rate when treated with the investigational chimeric antigen receptor (CAR) T-cell therapy JNJ-4528, which targets B-cell maturation antigen (BCMA), a protein commonly found...
In a study reported in the Journal of Oncology Practice, Nathwani et al found that the use of a tablet-based modified geriatric assessment during physician visits by older patients with multiple myeloma was feasible and provided physicians with information that influenced treatment decisions. Study ...
In 2018, researchers from Dana-Farber Cancer Institute launched a large, ambitious screening study called (PROMISE; ClinicalTrials.gov identifier NCT03689595) to identify people with premalignant precursor conditions of multiple myeloma, to understand the molecular signs of progression to myeloma...
As reported in The Lancet by Michel Attal, MD, and colleagues, the phase III ICARIA-MM trial has shown that the addition of the CD38-targeted antibody isatuximab to pomalidomide and low-dose dexamethasone significantly improved progression-free survival in patients with relapsed and refractory...
I was just 39 in 2015 when I was diagnosed with multiple myeloma. I have a wife and three young children whom I love, a challenging and fulfilling career, and I wasn’t ready to die. When I was first diagnosed, I met with a medical oncologist who had little experience treating this type of cancer....
In late 2018, elotuzumab was approved for use in combination with pomalidomide and dexamethasone for the treatment of adult patients with multiple myeloma who have received at least two prior therapies, including lenalidomide and a proteasome inhibitor.1 Supporting Efficacy Data Approval was based ...
The term “relapsed/refractory multiple myeloma” is often used to describe advanced myeloma that has progressed through primary or salvage therapy. The International Myeloma Working Group (IMWG) defined the term in 2011 as disease that is “nonresponsive while on salvage therapy or progresses...
In a phase IIb study (STORM Part 2) reported in TheNew England Journal of Medicine, Ajai Chari, MD, of Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, and colleagues found that oral selinexor and dexamethasone were active in some patients with multiple myeloma refractory to prior...
In a phase IIb study (STORM Part 2) reported in The New England Journal of Medicine, Ajai Chari, MD, of Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, and colleagues found that oral selinexor and dexamethasone were active in some patients with multiple myeloma refractory to prior...
In a phase III trial reported in the Journal of Clinical Oncology, Sagar Lonial, MD, and colleagues found that lenalidomide significantly improved progression-free survival vs observation in patients with intermediate- or high-risk smoldering multiple myeloma. As noted by the investigators,...
On September 26, 2019, daratumu-mab (Darzalex) was approved in combination with bortezomib, thalidomide, and dexamethasone for the treatment of multiple myeloma in newly diagnosed adult patients eligible for autologous stem cell transplantation (ASCT).1,2 Supporting Efficacy Data Approval was based ...
The number of approved agents in multiple myeloma has skyrocketed in recent years, leading to significant improvements in survival, but questions remain regarding the optimal duration of treatment. Although traditionally limited to a fixed number of cycles due to accumulating toxicity, novel agents ...
In the phase III TEAMM trial reported in The Lancet Oncology, Drayson et al found that prophylactic treatment with levofloxacin during the first 12 weeks of multiple myeloma treatment in newly diagnosed patients was associated with a significant reduction in first febrile episodes or death from any ...
African American and Hispanic patients with multiple myeloma generally start treatment with novel therapy significantly later than white patients, according to a study published by Ailawadhi et al in Blood Advances. The study found that, on average, it took about 3 months for white patients to...
A study published by Freeman et al in JNCCN—Journal of the National Comprehensive Cancer Network found that generally, providers with more experience treating multiple myeloma have better outcomes than those with more limited experience. Providers who saw the most cases were more likely to be...
Jorge J. Castillo, MD, of Dana-Farber Cancer Institute, discusses the many advances in treating relapsed and/or refractory multiple myeloma, including novel immunomodulators, proteasome inhibitors, and monoclonal antibodies, as well as emerging treatments such as chimeric antigen receptor T-cell therapy and antibody-drug conjugates.
Nina Shah, MD, of the University of California, San Francisco, discusses the debate on fixed duration vs waiting until disease progression, a key question for clinicians treating patients with multiple myeloma.
On September 26, 2019, the U.S. Food and Drug Administration approved daratumumab (Darzalex) in combination with bortezomib, thalidomide, and dexamethasone for newly diagnosed adult patients with multiple myeloma who are eligible for autologous stem cell transplant (ASCT). Efficacy was investigated ...
Recently, the U.S. Food and Drug Administration (FDA) granted Breakthrough Therapy designation to tepotinib for metastatic non–small cell lung cancer harboring MET exon 14 skipping alterations, and Orphan Drug designations to novel chimeric antigen receptor T-cell therapies in both multiple myeloma ...
On June 27, 2019, daratumumab was approved for use in combination with lenalidomide and dexamethasone for patients with newly diagnosed multiple myeloma who are ineligible for autologous stem cell transplantation.1,2 Supporting Efficacy Data Approval was based on findings in the open-label phase...
Early intervention in smoldering multiple myeloma prevents progression to symptomatic disease and should be strongly considered for patients meeting new criteria for high risk, according to Sagar Lonial, MD, Professor and Chair of Hematology and Medical Oncology and the Anne and Bernard Gray...