The 4:30 presentation titled “Therapy Excluding Transplantation: Combination Therapy For Newly Diagnosed Multiple Myeloma,” was, in a way, more of the same. Very similar data to other presentations I saw today, with a few key differences. In elderly patients, it turns out the Italians treat their patients in a way similar to those in Spain. (See previous post) Both think once weekly Velcade is enough. Thats good, right? Both studied combinations of Velcade/melphalan/prednisone and Velcade/melphalan/prednisone/thalidomide. A major difference is in the Italian study, led by Dr. Antonio Palumbo, used a two drug maintenance therapy low dose combo of Velcade and thalidomide, where the Spanish study continued to use low doses of all four drugs in their maintenance program. The Italians noted a 40% better response rate when maintenance therapy was used. Adding thalidomide made a difference in patients early on as well. 18% more patients reached a complete response, and achieved CR more quickly than the study arm not using thalidomide.
I met Dr. Palumbo last evening. Quiet, unassuming and considered among Europe’s best myeloma docs. In both Spanish and Italian studies, around 80% of these older patients were still alive after 3 years.
Now to younger patients. A number of three and four drug combinations were tried, involving Velcade/Revlimid/Cytoxan or Velcade/Revlimid/Cytoxan/Dex or Revlimid/Velcade/Doxil. (Can you tell this was an American study?) Honestly, I’m not a physician or clinitian, but there wasn’t that much difference. All worked! Only surprise was Rev/Vel/Dox combo did the best. But really, this study was about combinations, not specifics. It was a Phase II study and deemed successful. On to Stage III! Dr. Kumar, the face of this study, was asked a great question by a Florida doctor in the audience: “If you use all of these drugs up-front, will there be any options left for a patient after the myeloma adapts?” Dr. Kumar answered assertively that the idea here is to put the myeloma into such a deep CR that when it does begin to return, it will advance more slowly and actually be less resistant to drugs. In other words, they are trying to change the vary nature or progression of the disease. So, when it does return, a multi-drug combination should work again. Pretty cool, I thought! I had wondered about that myself. Good answer, but since there is no proof yet that their theory is correct, I still question the approach. At least they are studying something new–something a bit out of the ordinary.
I’m off to this evening’s Carfilzomid presentation. Since it runs to 10 PM and I really need to get some sleep, I will get you that info first thing Monday morning.
Feel good and keep smiling! Pat