As the hubbub around ASCO 2018 comes to an end, what are the main takeaways?

For sure, the media blitz distorts the importance of some presentations versus others. In most cases, study results are preliminary, with further follow-up and traditional peer reviews still pending.

With these caveats, one presentation (Abstract #8000), A.R.R.O.W (A randomized open-label study with Relapsed and refractory myeloma Receiving carfilzomib in combination with dexamethasone comparing Once Weekly versus twice weekly carfilzomib), is exceptional in that not only do results demonstrate value for the convenient once-weekly schedule, but the results have been simultaneously published with peer-review in The Lancet. The safe, once-weekly carfilzomib schedule produced longer remissions (PFS 11.2 months versus 7.6 months).

A sobering cautionary abstract was from the FDA (Abstract #8008) summarizing results from the checkpoint inhibitor, pembrolizumab, trials KEYNOTE-183 (pembrolizumab/pomalidomide/dexamethasone) (Abstract #8021) and KEYNOTE-185 (pembrolizumab/lenalidomide/dex) (Abstract #8010). Very encouraging results had been presented in the past, but ultimately dangerous immune toxicities emerged, prompting the FDA to halt the trials and review the data. Clearly, caution with early results is important.

Results with the bb2121 CAR-T trial were again presented in Abstracts #8007 and #8024. Key points were the median remission duration (PFS 11.8 months) and high level of some degree of MRD negativity, although only 2 patients out of 9 were at the 10-6 sensitivity level. So, continued encouraging results with more to follow.

For other myeloma studies, there were really no surprises. The combination of pomalidomide Vd showed superiority over Vd in patients refractory to lenalidomide (Revlimid®), which is very encouraging for patients (Abstract #8001). The combination of the new agent venetoclax with carfilzomib (Kyprolis®) showed a high response rate (88% overall) in both high- and low-risk patients (Abstract #8004).  It was also good to see that the combination of daratumumab with carfilzomib was very safe and was effective in lenalidomide-refractory patients, with a median remission duration (PFS) of 14 months  (Abstract #8002).

Thus, through the media blitz, there are important messages for patients! We are privileged to have a series of videos from top opinion leaders who emphasize in their own words the significance of these presentations I have mentioned. Each meeting gives us small steps forward to improve outcomes for myeloma patients.

Dr. Durie sincerely appreciates and reads all comments left here. However, he cannot answer specific medical questions and encourages readers to contact the trained IMF InfoLine staff instead. Specific medical questions posted here will be forwarded to the IMF InfoLine. Questions sent to the InfoLine are answered with input from Dr. Durie and/or other scientific advisors and IMWG members as appropriate, but will not be posted here. To contact the IMF InfoLine, call 800-452-CURE, toll-free in the US and Canada, or send an email to InfoLine hours are 9 am to 4 pm PT. Thank you.

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