As promised, here is the final installment of my three part report on the IMF’s ASH kick-off panel discussion Friday evening at the Peabody Hotel in Orlando:
I have already written two articles about Friday evening’s IMF panel of experts program, Key Myeloma Questions for 2010: Latest Developments in Diagnosis, Prognosis and treatment.
Let’s conclude with M.D. Anderson’s Dr. Robert Orlowski, along with a Q/A session with the panel of experts. I wanted to treat this section separately from the others, since it deals with new, promising therapies.
Dr. Orlowski shared his views on upcoming promising approaches and therapy options. He mentioned carfilzomib, which Dr. Orlowski is helping to research now as Onyx waits for FDA approval.
Celgene’s pomalidomide came next. Both carfilzomib and pomalidomide are active, single agent novel therapies. Dr. Orlowski feels both will help revolutionize myeloma therapy.
Vorinostat, manufactured by Merck, CNTO 328 and CO328T06 are combination drugs which expecially excite Dr. Orlowski. These drugs work best when combined with either Velcade or Revlimid, enhancing the primary novel therapy agent’s performance.
He discussed how the Vorinostat and Revlimid combo has about a 50% response rates in relapsed patients.
Then he moved on to Elotuzumab which, when combined with Revlimid and dex, features a response rate of over 80% among relapsed patients.
In a statement which surprised me, Dr. Orlowski shared how M.D. Anderson is excited about combining Revlimid and Thalomid, along with dex. It doesn’t sound fun, but this combination therapy appears to overcome sensitivity to either Revlimid or Thalomid alone.
Dr. Orlowski singled out an example of a patient who relapsed after SCT, was given Carfilzomib and Velcade with a CR response but then relapsed again one year later. What worked then? Rev/Thal/dex were able to gain another complete response!
ARRY520 looks promising because there is no neuropathy associated with its use. Good responses in heavily pre-treated patients so far.
Dr. Orlowski emphasised there are dozens more promising anti-myeloma therapies in the pipeline.
After thanking the audience, there was a short Q/A session which re-hashed much of what had been covered previously.
The main thrust of debate was hypothetical: Maintenance therapy, using Revlimid, is not currently approved in Spain, Italy or France. But if it were available to them, would the European docs use maintenance after SCT for their patients? All three European experts answered yes!
Why? I will follow-up this article with a press release from Celgene, highlighting results from a new study which continues to confirm how maintenance therapy extends disease-free progression–and in this study also extends median life expectancy significantly.
I’m not saying maintenance therapy is a slam dunk yet, or I agree with any of this as a patient. And yes, it is a Celgene sponsored study. But it is getting harder to argue with new maintenance data like this. And it is this data which prompts an overwhelming hypothetical response from these European experts.
Stay tuned! Feel good and keep smiling! Pat