If your read Friday’s post about my emotional evening at the IMF’s International Jounalist event last week, you will probably recall how my roller-coaster “crashed down” after hearing about an unexpectedly short, 8 month overall survival (OS) benefit from using pomalidomid and dexamethasone after patients became refractory to Revlimid and Velcade.
Today let’s work to push that roller-coaster back up and get it going again!
Like he had during the IMF’s Satellite Symposium the evening following the first day at ASH, M.D. Anderson’s Dr. Robert Orlowski, discussed carfilzomib related clinical study results–but this time in more detail.
As I touched-on at the end of Friday’s article, Dr. Orlowski is enamored with multiple myeloma therapy combinations, as he should be.
Dr. Orlowski discussed at length how possibly combining both pomalidomide and carfilzomib–and possibly other, existing drugs–might yield a much greater survival benefit than the short 8 months achieved by pomalidomide and dex alone.
It is clear to me combination chemotherapy is the future of multiple myeloma therapy. Dr. Orlowski’s presentation of his favorite study results from ASH reinforces this point.
Dr. Orlowski chose to review the results of combo study involving carfilzomib, Revlimid and dex.
Among newly diagnosed patients, 100% responded positively, with 90% achieving what he considered a high quality response.
Among relapsed and refractory patients, up to 52% responded–and with far less peripheral neuropathy than patients who used Velcade.
Now that’s more like it!
The study is still too new to reveal much about any overall survival benefit. But even so, that is an encouraging response rate among heavily pre-treated patients.
Let’s face it. At this point, data from ongoing clinical studies involving pomalidomide and carfilzomib aren’t giving us a complete picture.
Some dust needs to settle first. Researchers simply need more time.
Overall trends are what’s important here. And for the most part the new, novel therapy arrow continues to point up and in the right direction.
But for me, the question facing many of us longer lived multiple myeloma survivors is this: Will all of optimism and potential come together in time to help keep us alive?
After Dr. Orlowski completed his 20 minute formal presentation, he stuck around to answer questions from the foreign press. So while you mull my all-important question over, let me share some other therapy-related tidbits–some good and some not so good–that Doctors Orlowski and Durie revealed during the sort, post event Q & A.
From earlier posts, you may recall that Dr. Orlowski feels the elotuzomab antibody may hold one of the keys to significantly longer overall patient survival.
But I didn’t realize how excited Dr. Durie was about elotuzomab’s potential.
Both admitted that there wasn’t enough data available yet, but preliminary results of a new Revlimid/dex vs Revlimid/elotuzumab/dex study look exciting.
Re-visiting carfilzomib, Dr. Orlowski noted what might be the most important things about carfilzomib. Since patients tend to experience fewer side-effects while using carfilzomib than Velcade, theoretically they can stay on the drug longer. This ability for myeloma docs to keep patients on carfilzomib continually for years at a time, may in fact be the drug’s key to improving both progression free survival and overall survival stats.
That’s good! But the next carfilzomib related news isn’t so good.
Dr. Orlowski “let slip” that approval of carfilzomib by the FDA could be delayed for a year or more beyond July. He admitted that it wouldn’t surprise him if the FDA required more Phase 3 data from the ongoing Revlimid/dex vs Rev/carfilzomib/dex study he referred too earlier.
That’s not so good.
But don’t forget that both carfilzomib and pomalidomide are currently available through compassionate use provisions. An example of this is 20+ year survivor and good friend Mike Katz. Mike recently started using pomalidomide after a undergoing a long, five month application process.
But the point is he was eventually able to gain access to the drug–and it’s already working exceptionally well for him!
See what I mean by an up and down roller coaster ride? Over the course of a single evening, I felt hope, despair, frustration and joy.
Let me leave you with Dr. Orlowski’s last thought at the event. Answering the oft asked question about whether new novel therapies will someday replace auto stem cell transplants, Dr. Orlowski responded with a qualified “yes.”
Dr. Orlowski clearly believes SCTs will become a less important part of myeloma therapy someday.
“And when would that be?” a reporter asked. “Not until a number of these newer drugs become available in five or ten years.” he answered.
Five or ten years? That’s a relatively short blip in time for oncology clinicians. But for those of us with the disease, it could be a lifetime.
Feel good and keep smiling! Pat