Synergy at the 7th Annual IMWG Summit was the hallmark of this year’s event in Copenhagen, Denmark. Despite very tight scheduling—many key speakers flew directly from the annual meeting of the American Society of Clinical Oncology (ASCO) in Chicago—the level of engagement and collaboration was remarkable. “I feel a strong sense of myeloma community,” observed Prof. Philippe Moreau, an IMWG Summit co-chairman. “The top myeloma investigators in the world all working together to achieve common goals.”

Hot topics in myeloma

This was certainly true. The tone was set by Dr. Sigurdur Kristinsson, who outlined the iStopMM (Iceland Screening Treatment Or Prevention) program. Just as Iceland’s soccer team is capturing the imagination of the sports world, the iStopMM trial, which will test everyone in Iceland age 40 and over for MGUS, has captured the imagination of the medical world.  Not only will we learn about the early evolution of myeloma from this Black Swan Research Initiative®-supported project, we also have the potential to prevent or cure myeloma for a whole country! During the Copenhagen meeting, the iStopMM research team met separately to plan details for the full launch of this program in the fall of 2016.

After this inspiring start, very lively and cohesive discussions emerged after presentations on the key topics for this year’s Summit: “The Role of MRD;” “The Optimal Use of Imaging;” “The New Role of Immune Therapies;” “Options to Cure Myeloma;” “Sequencing versus iFish Testing” (Is iFish Testing Dead?!);” “Pros and Cons of Frontline Autotransplant;” and last but not least, “Treatment Recommendations Considering Access and Cost.”

A patient’s perspective

A unique session involved role playing by the IMF Senior Vice President of Clinical Education and Research Initiatives Lisa Paik, who played the part of Dr. Vincent Rajkumar’s anxious patient. She very nicely portrayed a myeloma patient who had been informed that her bone marrow was MRD positive. The segment really resonated with the audience of myeloma experts, who daily face the challenge of discussing MRD testing and results. It was clear that to avoid upsetting patients like the one Lisa played, physicians must be prepared to explain what MRD positive means and whether or not MRD positive status will require new treatment. (I will discuss these questions about MRD in my blog next week.)

IMWG productivity escalates

Progress and collaboration among the IMWG investigators were reflected by the recent updating of the “Uniform Response Criteria” to include MRD testing. We anticipate that the update will be published as a new IMWG guideline in The Lancet Oncology within two months. Also about to be published are the imminent publication of the new IMWG PET/CT guidelines to standardize use and interpretation of this important imaging technique. The Bone Disease Working Group of IMWG has been particularly active—MRI guidelines have also been published and the study comparing whole-body low-dose CT (WBLD-CT) with routine skeletal survey X-rays is just being completed. It is anticipated that WBLD-CT can be used as a much better method for routine screening and monitoring for myeloma bone disease.

Excitement over immune therapies

The very exciting results achieved with immune therapies were presented and discussed, and there was particular enthusiasm about the results of the CASTOR (dara + Vd) and POLLUX (dara + Rd) trials presented at ASCO and EHA respectively. The fact that the dara + Rd combination produced 30% MRD negativity in relapsed patients indicates the powerful impact of the new immune combinations.

To transplant or not to transplant

The heated debate between Dr. Sergio Giralt (pro-frontline autotransplant) and Dr. Sagar Lonial (against) led to very animated discussions. Ultimately, the audience overwhelmingly supported the notion that early/frontline ASCT is valid and continues to improve outcomes even in the setting of novel therapies.

Focus on cost

Perhaps the liveliest debate revolved around how to determine “best therapies” in this era of rising drug costs and, potentially, limited access. There was a strong consensus that IMWG members had a responsibility to provide prudent guidance. Active discussions in the workgroup session on costs resulted in two planned initiatives:

  • A publication that would simplify and stratify myeloma treatment recommendations based on efficacy, access, and current cost. Drs. Philippe Moreau, Vincent Rajkumar, and I are taking the lead on this.
  • A “stakeholders” meeting to continue the discussion of how to address treatment cost issues will be organized by Dr. Jean Luc Harousseau, who led the breakout group on “costs” so ably at the IMWG Summit.  Those stakeholders will include patients, myeloma experts, drug makers, health economists, and payers (i.e. insurance companies and health maintenance organizations).

The end of the afternoon of the first day was capped off with a full menu of “Work Group” discussions. As usual, multiple publications and work projects will evolve from these meetings.

Lifetime Achievement Award

As usual, the Robert A. Kyle Lifetime Achievement Award ceremony finished off the evening with a truly wonderful event, honoring Dr. Vincent Rajkumar, the 2016 recipient, held at the Borsen, the Danish stock exchange building built in the early 1600s. An unexpected treat was a brio musical performance by the recipient himself, Dr. Philippe Moreau (both on guitars), and IMF Senior Vice President Global Medical Affairs and Strategic Partnerships Pierre Sayad on keyboard. The group musically “roasted” several IMWG members to a standing ovation. The stellar evening was concluded with the emotional acceptance speech from Vincent, who was enthusiastically endorsed as the most deserving 2016 awardee!

This amazing day was followed by the wrap-up session the next day. It was a memorable 2016 IMWG Summit, bringing the IMWG members together as a true myeloma community to work for patients everywhere.

Image of Dr. Brian G.M. DurieDr. Brian G.M. Durie serves as Chairman of the International Myeloma Foundation and serves on its Scientific Advisory Board. Additionally, he is Chairman of the IMF's International Myeloma Working Group, a consortium of nearly 200 myeloma experts from around the world. Dr. Durie also leads the IMF’s Black Swan Research Initiative®.

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