I listened to a pre-ASCO teleconference today with the International Myeloma Foundation’s (IMF) Dr. Brian Durie. The preview was titled:
NEW PARADIGMS OF TREATMENT- FIRST LOOK AT LONG-TERM DATA FROM 2 MULTI-NATIONAL TRIALS EVALUATING MYELOMA MAINTENANCE THERAPY AFTER TRANSPLANT.
I have been covering a number of the studies Dr. Durie was discussing. The big news (no surprise) was Revlimid maintenance therapy almost doubled disease free progression when compared to patients who went without maintenance after transplant.
Velcade had similarly good results. Here the emphasis is on combination studies. Bottom line: Adding Velcade almost always improves quality and length of response. You can read more about this by going to a story I wrote about this a week ago.
Dr. Durie noted a study, first introduced at ASH, comparing transplant to Novel therapies. So far, no difference!
I want to pause here and note none of these maintenance or combination studies have shown hard evidence of extended median life expectancy rates. Why? It’s too soon—the studies are too new. Great news: There aren’t enough patients dying to capture needed statistics!
Dr. Durie also made a second presentation: ADVANCES IN TREATING MULTIPLE MYELOMA LEAD TO NEW TREATMENTS FOR OTHER BLOOD CANCERS AND EVEN SOLID TUMORS! I discussed this on my other www.HelpWithCancer.Org site Sunday, May 23,
Carfilzomib continues to impress, according to Dr. Durie. He then moved on to gene expression profiling. Can we begin to classify different types of myeloma—and, if so, how might that affect a doctor’s therapy choices.
PAUSE. This literally is a tele-news conference. We are now into the Q & A. Questions are focusing on progression free survival and maintenance therapy. Dr. Durie took time to discuss toxicities and how they effect these ongoing studies. Bottom line: New novel therapies are, for the most part, well tolerated.
An interesting question was just asked about re-immunization post transplant. Dr. Durie’s response: Immunity does recover slowly over first year post-transplant. So controversy centers on whether to re-immunize at the one year point. The myeloma community is split, but recently there has been a shift away from re-vaccination—most centers no longer do it.
A questioner asked: “Dr. Durie, earlier you described the results from the Rev/Val/dex studies as ‘spectacular.’ If they are so great, why not just use that therapy for every patient?”
Dr. Durie’s response: “We don’t want to just jump in and go to this combination therapy until we have more scientific results. If you use Velcade and Revlimid together right away, you take away the option of using one or the other later. How does this effect longevity?” Dr. Durie went on to discuss other three, four and five drug combo’s. All are working—none currently have proof of extended longevity.
Dr. Durie did address the major underlying controversy in the myeloma community: Do we push for a cure or treat myeloma as a chronic disease? Dr. Durie’s position is: as long as we can minimize the side effects—since there isn’t officially a “cure” available—why not use these different novel therapies to help keep patients alive.
I look forward to seeing Dr. Durie in Chicago next week. He brings an intelligent calm and focus to these issues. His ultimate goal: To help coordinate world-wide multiple myeloma studies so they work in concert—so time and resources aren’t wasted.
Thanks for reading! Feel good and keep smiling! Pat