ASH 2014 Update -Highlights of the meeting for Myeoma patients

Prof O’Gorman is currently attending the American society of Hematology in San Francisco. Here gives an update on the highlights of the meeting for Myeoma patients.

In summary this meeting provided huge hope for the future for patients with Myeloma. We heard about new drugs like Velcade(proteosome inhibitors) that show better response rates eg Carfilzomib. We heard about the first oral proteosome inhibitor Ixaxomib. We heard about the latest IMID drug Pomalidomide. The Stratus trial enrolled 25 Irish patients and was led in Ireland by Prof O Gorman. Most excitingly we heard about an entirely new class of drugs called monoclonal antibodies that show efficacy and tolerability in patients who have failed all existing treatments. For a detailed summary of the sessions see below.

Speaker 1 Dr Keith Stewart Presented on the Aspire trial – Comparing carfilzomib(Kyprolis) plus Lenalidomide(re limpid) plus dexamethasone (KRD regimen)to Lenalidomide plus dexamethasone(RD) in patients with early relapse of Myeloma. The patients on KRD received Carfilzomib 27mg/m2 days 1,2,8,9,15,16 withe standard dose Lenalidomide and dexamethasone. In course 1 the dose of Carfilzomib was reduced to 20mg/m2. After 18 cycles the Carfilzomib was stopped and the Lenalidomide continued. The results were very impressive with a delay of relapse by 8.7 months at the 18 month time point and a significant improvement in overall survival. Just as important was the observation of a low rate of side effects in particular cardiac and respiratory and small differences between the two arms.

Next speaker was Dr Dimopoulus to discuss the Stratus trial. Approximately 25 Irish patients were enrolled in this trial which closed in Novemebr 2014. Prof O Gorman was the Irish lead investigator. As the trial has very recently closed the information was preliminary. An overall response rate of 35% was reported. This is particularly impressive as unlike the Aspire trial the patients in this trial had failed treatment with Lenalidomide and velcade prior to enrolment. This indicates that Pomalidomide is a very good option for these patients. Pomalidomide is currently being assessed by the NCPE for approval in Ireland. We expect a decision shortly.

Dr Kumar presented the results of the phase 1/2 study of Ixaxomib in newly diagnosed Myeloma. This is the first oral proteosome inhibitor. It is taken 4mg once weekly and combined with Lenalidomide 25mg day 1-21 and dexamethasone 40mg weekly. Apart form skin rash and diarrhoea it was well tolerated. Overall response rate was 90% with a complete remission (CR) rate of 22% and very good partial response (VGPR) OF 59%. There was increasing response during the maintenance period. This all oral regimen is a very exciting model for future myeloma treatment.

The most exciting part of an excellent session was in the last two talks on new monoclonal antibodies SAR650984 and Daramtumumab. Both studies combined the treatments with Lenalidomide and dexamethasone. Both studies showed high response rates of in patient groups who had failed all available therapies. Side effects were manageable. If these drugs are used earlier in the disease eg at presentation we would expect even better responses.

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