Yesterday I shared Dr. Stewart’s hopeful message to patients for whom
Revlimid and Velcade no longer work. Here is his response to the question:
Should I consider a clinical trial? What new therapies in clinical trials look promising?
as posted on the Multiple Myeloma Research Foundation (MMRF) site recently:
Clinical trials are an important option for patients who have failed Revlimid and Velcade. There are numerous new agents that are being studied today. Many of these agents are being studied in combination with Revlimid or Velcade. It appears that when Revlimid or Velcade are combined with other drugs, patients may become re-sensitized and may be able to achieve a response once again.
Carfilzomib and pomalidomide are two myeloma drugs that that appear to be particularly promising:
Carfilzomib is a proteasome inhibitor that is chemically related to Velcade, but may have less neuropathy associated with its use. A recent Phase II study in 266 patients showed that 36% of patients who had failed all available anti-myeloma treatments responded to carfilzomib, with 24% of patients achieving a partial response or better. A Phase III trial is underway which is evaluating the effectiveness of carfilzomib in combination with Revlimid-dex as compared to Revlimid-dex.
Pomalidomide is chemically related to both Thalomid and Revlimid and appears to be active in patients who have failed Revlimid and Velcade. In a small early study, approximately one-third of patients benefitted from treatment with this agent in combination with dexamethasone. Phase III trials evaluating this drug will begin later this year.
Other types of agents that have shown encouraging results in early studies include:
•HDAC (histone deacetylase) inhibitors: Panobinostat and Zolinza® (vorinostat) are HDACs that are being tested in a Phase III studies in combination with Velcade. Zolinza is currently approved by the FDA for another type of cancer.
•Perifosine: Perifosine is an oral anticancer agent that is being studied in a phase III study in combination with Velcade.
•Treanda® (bendamustine): Treanda is a chemotherapy traditionally used for other cancers. It appears to be useful in patients with relapsed and/or refractory myeloma. It is being studied in a number of clinical trials including combinations with Revlimid-dex and Velcade.
•Monoclonal antibodies which specifically target myeloma cell or interfere with the growth of myeloma cells: Elotuzumab, particularly in combination with Revlimid-dex has shown encouraging results in early studies. In addition, CNTO 328, has shown some promising activity in combination with Velcade.
Thank you, Dr. Stewart! A good place for relapsed/refractory patients to start.
Feel good and keep smiling! Pat