I posted this comment on our My Cancer Store wall yesterday: “I thought about dropping all of the technical stuff until after Christmas. But the deeper I dig-into results from ASH, the more hopeful and excited I get! And hope is what the holiday is all about, right?”
Yesterday I had a long visit with my myeloma specialist, Dr. Melissa Alsina, at Moffitt Cancer Center. One of the things I learned was that she was at ASH, too. So I asked her what she thought about the trial results presented there.
“I didn’t see anything that was really new.” She said. “But we are working with it all everyday.” Dr. Alsina continued, meaning she already had a good feel for changes that are in the works.
And that’s how I usually feel when in the middle of one of these conferences. Like I’m stuck in the middle of a “Ground Hog’s Day” movie loop and I’ve seen it all before.
But this year was different. This year, most every presentation I attended showed promise. Not for a cure, but the promise of more control and a longer life.
But others saw even more potential. Our old friend, Danny Parker, referred me to an article he read in Managing Myeloma, written by Doctor Philip L. McCarthy, Professor of Oncology and the Director of the Blood and Marrow Transplant Program, Roswell Park Cancer Institute in Buffalo, New York.
Like many of us, Dr. McCarthy admitted he was having trouble covering all of the myeloma related presentations. He covers many of the same programs I did.
Apparently he was unexpectedly taken-aback by M.D. Anderson’s ongoing work combining Revlimid with Thalomid. Danny and I noticed these results, too. He emailed me:
Shah et al. (MD Anderson) from ASH 2012, combo of Thal/Len/Dex produced 63% ORR in relapsed myeloma that was lenalidomide refractory!
And here’s what Dr. McCarthy had to say:
It seems that lenalidomide resistance may be mediated through the Wnt1/beta-catenin pathway in terms of cell signaling. Thalidomide works through a slightly different mechanism of action and while cereblon is important, we think that the combination of len/thal at least has some theoretical advantage. A couple of years ago, I would not have thought that, and in fact I said so publicly, that combined IMiD, I was not sure about its utility, but the MD Anderson group looked at the combination of lenalidomide and thalidomide in a dose-finding study. They actually had some complete responses in patients who had relapsed/refractory disease, so they now have a dose for both len and thal, and it remains to be determined what role this will be for future patients. But I think it allows the practicing clinician to at least consider these, of course with insurance approval, this combined modality treatment, and there is definitely data to support it.
But once again I have buried the lead. And so did Dr. McCarthy! Listen to what he had to say at the end of his lengthy ASH report:
There is lots of future research needed. We are going to spend a huge amount of time trying to develop new studies that will allow us to identify the patients who are in need of the most novel induction regimens that will allow us to better define which patient populations might even have the best chance at long-term cure.
Interesting how we all hear and see different things when watching, listening too and reading about different clinical trials. Dr. Alsina didn’t expect to see anything new in Atlanta–and she didn’t. Dr. McCarthy was surprised by some of the data he saw. So much so, it even got him thinking “cure.” Danny wasn’t there, but he approached things from his upbeat, positive point of view.
That’s why if never hurts to read different ASH summary articles, or listen to the post ASH result wrap-ups sponsored by groups like the IMF and MMRF. You or they may see something that can change how you look at myeloma and/or myeloma therapy.
I know I returned home feeling much more hopeful and positive than I did before I traveled to Atlanta. And truthfully, I have become a bit jaded after covering conferences like this–and experiencing many of the therapies and drugs they are discussing–for so many years.
My advice: Without getting bogged-down, look over data from a few of these many studies when you get a chance. No hurry. I (and others) will be presenting it to you well into the new year. Its OK to be a bit skeptical. After all, everyone has an agenda. But try and be open to possibilities. I’m convinced. It worked for me!
I almost forgot. Here is a link to the video featuring Dr. McCarthy and his impressions of ASH:
You will find a written transcript there, too.
Feel good and keep smiling! Pat