Dr Garderet speaks with ecancer at the 16th International Myeloma Workshop about the outcome of third salvage autologous stem cell transplantation in multiple myeloma.Autologous stem cell transplantation remains a standard treatment for younger patients with multiple myeloma. With the aid of new drugs, the patients live longer and third salvage ASCT is an increasingly used option.However, the outcome of third salvage autologous stem cell transplantation has not yet been analysed.

Dr Garderet speaks with ecancer at the 16th International Myeloma Workshop about the outcome of third salvage autologous stem cell transplantation in multiple myeloma. Autologous stem cell transplantation remains a standard treatment for younger patients with multiple myeloma. With the aid of new drugs, the patients live longer and third salvage ASCT is an increasingly used option. However, the outcome of third salvage autologous stem cell transplantation has not yet been analysed.

Outcome of third salvage autologous stem cell transplantation in multiple myeloma

Dr Lentzsch speaks with ecancer at the 16th International Myeloma Workshop about genomics and disease monitoring and debating wether precision medicine is more hype than reality.

Is precision myeloma medicine more hype than reality?

Monica Morris speaks with ecancer at the 16th International Myeloma Workshop about guidelines for screening and management of late and long-term consequences of myeloma and its treatment.

Long term effects of myeloma treatment

Monica Morris speaks with ecancer at the 16th International Myeloma Workshop about findings from a study into the experience of caring for myeloma patients.

Caring for multiple myeloma carers

Dr Garderet speaks with ecancer at the 16th International Myeloma Workshop about the highlights of IMW 2017, particularly antibodies and immunotherapy.

IMW 2017 highlights

Dr Lentzsch speaks with ecancer at the 16th International Myeloma Workshop about the CASTOR trial.The CASTOR trial is a phase III randomised controlled study of daratumumab, bortezomib, and dexamethasone (DVd) versus bortezomib and dexamethasone (Vd) in patients with relapsed or refractory multiple myeloma.

Dr Lentzsch speaks with ecancer at the 16th International Myeloma Workshop about the CASTOR trial. The CASTOR trial is a phase III randomised controlled study of daratumumab, bortezomib, and dexamethasone (DVd) versus bortezomib and dexamethasone (Vd) in patients with relapsed or refractory multiple myeloma.

Update on CASTOR trial: Daratumumab, bortezomib, and dexamethasone for relapsed or refractory myeloma

Prof Chng speaks with ecancer at the 16th International Myeloma Workshop about the landscape of current international trials in multiple myeloma, focusing on Asia-Pacific countries. He highlights the issues in variation of clinical practice and drug accessibility in the region, and why a clinical trial network has been set up.

Prof Chng speaks with ecancer at the 16th International Myeloma Workshop about the landscape of current international trials in multiple myeloma, focusing on Asia-Pacific countries. He highlights the issues in variation of clinical practice and drug accessibility in the region, and why a clinical trial network has been set up.

Asia-Pacific approaches to myeloma trials

Dr Lesokhin speaks with ecancer at the 16th International Myeloma Workshop about the biology behind immunotherapy in MM and its implications for the future.

What is the biology behind immunotherapy for MM?

Dr Majumder speaks with ecancer at the 16th International Myeloma Workshop about increased mutational burden and alterations to DNA damage repair genes are associated with poor prognosis and sensitivity to PI3K-mTOR inhibitors in multiple myeloma.

Impact of recurrent myeloma alterations on drug response

Dr Raje speaks with ecancer at the 16th International Myeloma Workshop about an international, randomised, double blind trial comparing denosumab with zoledronic acid for the treatment of bone disease in patients with newly diagnosed multiple myeloma.

Evaluating efficacy of denosumab compared with zoledronic acid in symptomatic myeloma

Dr Boccia speaks with ecancer at the 16th International Myeloma Workshop about the CHAMPION-2 study.The study evaluated different dose levels of carfilzomib in combination with fixed-dose cyclophosphamide and dexamethasone for the treatment of newly diagnosed multiple myeloma (MM).Carfilzomib is a selective and irreversible second-generation proteasome inhibitor. Carfilzomib (56 mg/m2) twice weekly combined with cyclophosphamide and dexamethasone had manageable toxicity and was effective for treating patients with newly diagnosed MM.

Dr Boccia speaks with ecancer at the 16th International Myeloma Workshop about the CHAMPION-2 study. The study evaluated different dose levels of carfilzomib in combination with fixed-dose cyclophosphamide and dexamethasone for the treatment of newly diagnosed multiple myeloma (MM). Carfilzomib is a selective and irreversible second-generation proteasome inhibitor. Carfilzomib (56 mg/m2) twice weekly combined with cyclophosphamide and dexamethasone had manageable toxicity and was effective for treating patients with newly diagnosed MM.

Carfilzomib, cyclophosphamide, and dexamethasone in newly diagnosed multiple myeloma

Prof Mateos speaks with ecancer at the 16th International Myeloma Workshop about an overview of sessions at IMW 2017, first discussing the rationale and mechanism of action for monoclonal antibodies (mAbs) in the treatment of myeloma.She then focuses on the clinical impact of some mAbs, including elotuzumab, daratumumab, isatuximab and checkpoint inhibitors.An overview of some of the key results for these treatments are discussed, highlighting the benefits that mAbs can provide to multiple myeloma patients.Summarising the future role of mAbs, it is suggested that results coming from daratumumab show that it should be a backbone to which the backbone regimes should be added.

Prof Mateos speaks with ecancer at the 16th International Myeloma Workshop about an overview of sessions at IMW 2017, first discussing the rationale and mechanism of action for monoclonal antibodies (mAbs) in the treatment of myeloma. She then focuses on the clinical impact of some mAbs, including elotuzumab, daratumumab, isatuximab and checkpoint inhibitors. An overview of some of the key results for these treatments are discussed, highlighting the benefits that mAbs can provide to multiple myeloma patients. Summarising the future role of mAbs, it is suggested that results coming from daratumumab show that it should be a backbone to which the backbone regimes should be added.

Monoclonal antibodies in multiple myeloma

Dr Niesvizky speaks with ecancer at the 16th International Myeloma Workshop about promising agents in phase II trials for the management of myeloma.He discusses the difficulty of integrating new agents into new molecules, and the challenge that patients face when trying to select effective drugs for their treatment.

Dr Niesvizky speaks with ecancer at the 16th International Myeloma Workshop about promising agents in phase II trials for the management of myeloma. He discusses the difficulty of integrating new agents into new molecules, and the challenge that patients face when trying to select effective drugs for their treatment.

Promising myeloma agents in phase II trials

Dr Salomon Manier speaks with ecancer at the 16th International Myeloma Workshop about cell-free DNA (cfDNA) and circulating tumour cells (CTCs) sequencing that enable serial temporal sampling.The team looked at whole-exome sequencing (WES) and ultra low pass-whole genome sequencing (ULP-WGS) of cfDNA and CTCs in multiple myeloma.The study demonstrated that WES and ULP-WGS of cfDNA and CTCs are consistently representative of tumour DNA alterations in terms of CNAs and SNVs.This approach could therefore be used to longitudinally follow clonal evolution and minimal residual disease in MM, personalising and improving treatment.It also reduces the need for bone marrow biopsy, greatly improving the patient experience.

Dr Salomon Manier speaks with ecancer at the 16th International Myeloma Workshop about cell-free DNA (cfDNA) and circulating tumour cells (CTCs) sequencing that enable serial temporal sampling. The team looked at whole-exome sequencing (WES) and ultra low pass-whole genome sequencing (ULP-WGS) of cfDNA and CTCs in multiple myeloma. The study demonstrated that WES and ULP-WGS of cfDNA and CTCs are consistently representative of tumour DNA alterations in terms of CNAs and SNVs. This approach could therefore be used to longitudinally follow clonal evolution and minimal residual disease in MM, personalising and improving treatment. It also reduces the need for bone marrow biopsy, greatly improving the patient experience.

Sequencing multiple myeloma using blood tests

Dr Zonder talks to ecancer at the 16th International Myeloma Workshop about emerging strategies tailoring immunotherapy to individual patients with multiple myeloma.

Examining strategies to tailor multiple myeloma immunotherapy

Dr Krishnan speaks with ecancer at the 16th International Myeloma Workshop about phase III trials in myeloma looking at optimal post transplant approaches to improve response.Autologous stem cell transplantation has been shown to improve progression free survival compared to standard dose chemotherapy for multiple myeloma in several phase III trials.However, despite major improvements in response to treatment, relapse remains the major cause of mortality.We now have sufficient evidence to justify the upfront use of autologous stem cell transplantation for suitable patients with myeloma.The use of maintenance therapy post transplant also can be justified on the basis of several randomised trials.Consolidation therapy remains a matter of controversy which may become clearer as the data from two large trials one in the US and one in Europe matures.The most definitive thing to note is that in all these trials overall survival is encouraging and suggests that we continue to advance in our therapy of multiple myeloma.

Dr Krishnan speaks with ecancer at the 16th International Myeloma Workshop about phase III trials in myeloma looking at optimal post transplant approaches to improve response. Autologous stem cell transplantation has been shown to improve progression free survival compared to standard dose chemotherapy for multiple myeloma in several phase III trials. However, despite major improvements in response to treatment, relapse remains the major cause of mortality. We now have sufficient evidence to justify the upfront use of autologous stem cell transplantation for suitable patients with myeloma. The use of maintenance therapy post transplant also can be justified on the basis of several randomised trials. Consolidation therapy remains a matter of controversy which may become clearer as the data from two large trials one in the US and one in Europe matures. The most definitive thing to note is that in all these trials overall survival is encouraging and suggests that we continue to advance in our therapy of multiple myeloma.

Ongoing transplant phase III trials for myeloma

Prof Maria-Victoria Mateos (University Hospital of Salamanca, Salamanca, Spain) talks to Prof Paul Richardson (Dana-Farber Cancer Institute, Boston, USA) discuss key advances in the treatment of smoldering multiple myeloma for ecancer at the 16th International Myeloma Workshop in New Delhi, India. With the standard of care for smoldering multiple myeloma (SMM) being observation, a number of trials have assessed the early treatment of selected SMM patients to identify whether alternative treatment options should be explored.Prof Mateos first discusses the QuiRedex trial that selected patients at high risk for progression. In these patients, early treatment with lenalidomide plus dexamethasone compared to observation provided a significant benefit both in terms of time to progression to active disease and overall survival.Further studies are discussed that if positive would support the use of early treatment for patients with high-risk SMM.Summarising the discussion, it was suggested that based on current evidence ultra-high risk SMM patients should be treated and “strive for cure”.With the potential for novel biological and genomic markers to more accurately predict the risk of progression, it is clear the therapeutic landscape for both high risk and ultra-high risk SMM patients is set to evolve.

Prof Maria-Victoria Mateos (University Hospital of Salamanca, Salamanca, Spain) talks to Prof Paul Richardson (Dana-Farber Cancer Institute, Boston, USA) discuss key advances in the treatment of smoldering multiple myeloma for ecancer at the 16th International Myeloma Workshop in New Delhi, India. With the standard of care for smoldering multiple myeloma (SMM) being observation, a number of trials have assessed the early treatment of selected SMM patients to identify whether alternative treatment options should be explored. Prof Mateos first discusses the QuiRedex trial that selected patients at high risk for progression. In these patients, early treatment with lenalidomide plus dexamethasone compared to observation provided a significant benefit both in terms of time to progression to active disease and overall survival. Further studies are discussed that if positive would support the use of early treatment for patients with high-risk SMM. Summarising the discussion, it was suggested that based on current evidence ultra-high risk SMM patients should be treated and “strive for cure”. With the potential for novel biological and genomic markers to more accurately predict the risk of progression, it is clear the therapeutic landscape for both high risk and ultra-high risk SMM patients is set to evolve.

How should we treat smoldering multiple myeloma? Expert discussion from IMW 2017

Professor Jesus San Miguel (University Hospital of Salamanca, Salamanca, Spain) outlines how the role of minimal residual disease (MRD) negativity has evolved to become part of the central narrative of how multiple myeloma is treated.In the 1980s a cure in multiple myeloma was considered unattainable due to the small proportion of patients achieving a complete response.However, with the introduction of new agents the landscape has changed.This movement led to the International Myeloma Working Group recently publishing a consensus criteria for response and minimal residual disease assessment in multiple myeloma.In this review several aspects of disease response assessment are clarified, as well as endpoints for clinical trials and future directions.Professor San Miguel adds that while the concept of MRD is usually associated with depth of treatment response in multiple myeloma, there could be growing utility around measuring treatment efficacy with long term follow up, as seen in other diseases.The impact that MRD negativity has on patients is then discussed, with clear associations between patients being MRD negative and a positive response.Whilst questions remain, the potential of MRD negativity being a surrogate marker for cure in multiple myeloma is a distinct possibility.

Professor Jesus San Miguel (University Hospital of Salamanca, Salamanca, Spain) outlines how the role of minimal residual disease (MRD) negativity has evolved to become part of the central narrative of how multiple myeloma is treated. In the 1980s a cure in multiple myeloma was considered unattainable due to the small proportion of patients achieving a complete response. However, with the introduction of new agents the landscape has changed. This movement led to the International Myeloma Working Group recently publishing a consensus criteria for response and minimal residual disease assessment in multiple myeloma. In this review several aspects of disease response assessment are clarified, as well as endpoints for clinical trials and future directions. Professor San Miguel adds that while the concept of MRD is usually associated with depth of treatment response in multiple myeloma, there could be growing utility around measuring treatment efficacy with long term follow up, as seen in other diseases. The impact that MRD negativity has on patients is then discussed, with clear associations between patients being MRD negative and a positive response. Whilst questions remain, the potential of MRD negativity being a surrogate marker for cure in multiple myeloma is a distinct possibility.

Evolving role of MRD negativity in multiple myeloma

Dr Krishnan speaks with ecancer at the 16th International Myeloma Workshop about the StaMINA trial, which looked at autologous haematopoietic cell transplant (autoHCT) followed by lenalidomide maintenance vs auto HCT and lenalidomide and bortezomib and dexamethasone consolidation lenalidomide maintenance vs tandem autoHCT lenalidomide maintenance The primary results of the largest randomised US transplant trial in multiple myeloma demonstrated comparable progression free survival (PFS) and overall survival (OS).The addition of dexamethasone consolidation or a second auto HCT was not superior to a single auto HCT followed by lenalidomide maintenance in the upfront treatment of multiple myeloma.Tandem autoHCT did not improve PFS or OS compared to single Auto HCT.Consolidation therapy with revlimid-velcade-dexamethasone had a trend towards improved PFS at 38 months but did not achieve statistical significance. However, the high 38 month survival in all arms is encouraging and is in keeping with the high PFS of the lenalidomide maintenance arms in the Myeloma XI trial (median PFS 60 months) and CALGB100104 (median PFS 53 months).Alternate strategies such as combinations with monoclonal antibodies pre and post transplant may lead to further improvements in PFS and OS in high risk patients.A long term follow-up trial to track outcomes in these patients is ongoing.

Dr Krishnan speaks with ecancer at the 16th International Myeloma Workshop about the StaMINA trial, which looked at autologous haematopoietic cell transplant (autoHCT) followed by lenalidomide maintenance vs auto HCT and lenalidomide and bortezomib and dexamethasone consolidation lenalidomide maintenance vs tandem autoHCT lenalidomide maintenance The primary results of the largest randomised US transplant trial in multiple myeloma demonstrated comparable progression free survival (PFS) and overall survival (OS). The addition of dexamethasone consolidation or a second auto HCT was not superior to a single auto HCT followed by lenalidomide maintenance in the upfront treatment of multiple myeloma. Tandem autoHCT did not improve PFS or OS compared to single Auto HCT. Consolidation therapy with revlimid-velcade-dexamethasone had a trend towards improved PFS at 38 months but did not achieve statistical significance. However, the high 38 month survival in all arms is encouraging and is in keeping with the high PFS of the lenalidomide maintenance arms in the Myeloma XI trial (median PFS 60 months) and CALGB100104 (median PFS 53 months). Alternate strategies such as combinations with monoclonal antibodies pre and post transplant may lead to further improvements in PFS and OS in high risk patients. A long term follow-up trial to track outcomes in these patients is ongoing.

Post autologous transplant therapies in high risk multiple myeloma: StaMINA trial update

Prof Terpos speaks with ecancer at the 16th International Myeloma Workshop about late breaking data from IMW 2017, assessing the efficacy and safety of denosumab compared with zoledronic Acid in newly diagnosed symptomatic myeloma patients.Targeting RANKL, this Phase III study with denosumab met its primary endpoint of non-inferiority to zoledronic Acid in delaying time to first on-study skeletal related events in patients with newly diagnosed myeloma.Denosumab also showed comparable overall survival and for the first time superior PFS compared with zoledronic Acid.Renal adverse events were also greatly reduced with denosumab.These results and the fact that denosumab can be administered subcutaneously, lead to the suggestion that it will become a new standard of care for the management of bone disease in multiple myeloma.

Prof Terpos speaks with ecancer at the 16th International Myeloma Workshop about late breaking data from IMW 2017, assessing the efficacy and safety of denosumab compared with zoledronic Acid in newly diagnosed symptomatic myeloma patients. Targeting RANKL, this Phase III study with denosumab met its primary endpoint of non-inferiority to zoledronic Acid in delaying time to first on-study skeletal related events in patients with newly diagnosed myeloma. Denosumab also showed comparable overall survival and for the first time superior PFS compared with zoledronic Acid. Renal adverse events were also greatly reduced with denosumab. These results and the fact that denosumab can be administered subcutaneously, lead to the suggestion that it will become a new standard of care for the management of bone disease in multiple myeloma.

Denosumab vs zoledronic acid for bone disease in newly diagnosed multiple myeloma

IMW 2017

What is this?
1 quote, 3 ideas & 1 question from a carefully curated podcast episode.
Every Monday & Wednesday.

Want a 3rd insight and episode every week? Email me at curation@owltail.com.

OwlTail

OwlTail 1-3-1

The best podcast episodes about true crime. For any thrill seeking podcast listeners who just can't get enough of the captivating stories of murderers and criminals. This topic has all the best episodes from many different true crime podcasts.  Add episodes you're interested into your queue below!