I know, I know. I’m falling behind! I’m so busy collecting and analyzing newly released myeloma related research data, I have barely had time to write.
Here is the final installment of my three part report about the IMF’s Friday evening Satellite Symposium.
I saved the best for last! Dr. Robert Orlowski with M.D. Anderson in Houston, spoke on the topic that I feel will interest the majority of my readers most: Novel (new) Agents and Regimens.
Dr. Orlowski outlined what he called a “cornucopia of new drugs,” including second generation protease inhibitors, second and third generation immunomodulators, histone deacetylase and novel signal transduction inhibitors.
ed and refractory patients in desperate need of something–anything to help slow their active and drug resistant myeloma, Dr. Orlowski specifically singled-out Onyx Pharmaceuticals’ new drug, carfilzomib.
He seemed impressed by the 25% response rate among heavily pre-treated and refractory patients.
Similarly, Pomalidomide worked in a large group of heavily pre-treated patients. Dr. Orlowski didn’t spend a lot of time on pomalidomide, except to show a slide which outlined ongoing pomalidomide studies. All look very good.
He felt Perifosine may help overcome resistance in some bortezomib (Velcade) refractory patients. This is an important quality, especially for patients who are running out of options.
Combining proteasome inhibitors with HDAC inhibitors show great promise, according to Dr. Orlowski. Examples of this include combining vorinostat with Velcade.
Dr. Orlowski briefly touched-on another new novel agent, panobinostat, which also worked well in Stage 2 and 3 studies.
Dr. Orowski and M.D. Anderson have been hosting clinical trials featuring the monoclonal antibody, elotuzumab. Data from several different studies involving elotuzumab when used in combination with lenalidomide and dexamethasone will be revealed Monday. These results are embargoed, but Dr. Orlowski did reveal that elotuzumab is expected to show up to a 90% partial response rate, even among patients who had been pre-treated with Velcade and Revlimid.
Like Dr. Orlowski announced last year, combining Revlimid and thalidomide shows surprising promise, similar to other therapies mentioned above.
And why not? When in doubt, bring back older therapies, combine them with new ones and try it again!
Unfortunately, patients who become refractory to both Revlimid and Velcade have a poor prognosis once salvage therapy begins–Dr. Orlowski noted that the median overall suvival (OS) is less than one year.
By adding one or more of these newer, experimental drugs, Dr. Orlowski hopes this narrow window can be extended substantially.
The problem continues to be that researchers don’t yet understand how and why myeloma can become drug resistant so quickly.
So while new drugs like carfilzomib and pomalidomide offer hope, until researchers can find a way to “switch-off” this drug resistance, they are only Band-aids.
Almost as an afterthought, Dr. Orlowski did throw it a bit of data about ARRY520 and mentioned several older, existing drugs like Cytoxan and Doxil, which also offer hope during salvage therapy.
I must admit I was a bit emotional after listening to Dr. Orlowski Friday night.
He was the last speaker and it had been a long day. But I couldn’t help but thank God that my RVD (Revlimid/Velcade/dex) therapy seems to be working. Because based on data he presented in his presentation, being refractory (I’m too close to comfort!) to both Revlimid and Velcade isn’t a good thing.
Dr. Orlowski didn’t address this issue directly, but the currently disappointing salvage therapy stats don’t include carfilzomib, pomalidomide or a number of the other therapy agents which enhance the effectiveness of Velcade and Revlimid.
So there is hope–based on a number of new drugs in the pipeline–for refractory and heavily pre-treated patients.
I spoke briefly with Dr. Orlowski after the program. It wasn’t an interview, but I walked away feeling relieved yet apprehensive.
It is clear to me that researchers are still searching for that magic “silver bullet” for patients undergoing salvage therapy. Hopefully study results about one or more novel therapies Dr. Orlowski mentioned will go a long way toward identifying possible options this weekend.
A guy can dream, right? I can’t wait to get started!
Feel good and keep smiling! Pat