In this video, Dr. Luciano Costa (University of Alabama, Birmingham, Alabama) provides his overview of multiple myeloma research that was presented at ASCO 2018. He discusses the following studies:
- The phase III ARROW study that compares standard low-dose carfilzomib administered twice weekly compared with high-dose carfilzomib administered once weekly to MM patients who have had two to three lines of prior therapy. Investigators found that patients treated once weekly with the higher dose had a reduced risk of disease progression.
- A study from Dr. Paul Richardson (Dana Farber Cancer Institute, Boston) that compared pomalidomide + dexamethasone with pomalidomide + bortezomib + dexamethasone in multiple myeloma patients who were refractory to lenalidomide. This study showed a significant decline in the risk of disease progression in patients on the three-drug versus two-drug combination. The study – still in its early stages – is important because it demonstrates that even though patients may be refractory to one immunomodulatory agent (lenalidomide), they still may benefit from the use of another immunomodulatory agent (pomalidomide). The study also solidifies that three-drug combinations as opposed to two-drug combinations have better outcomes for MM patients who have experienced a relapse.
- A phase II study on carfilzomib + venetoclax (the B-cell 2 inhibitor) in a population of myeloma patients who have had two prior lines of therapy, with the majority of these patients being refractory to their last line of therapy. The study found a high-response rate (83%) in these patients, with a similarly high-response rate in patients with high-risk chromosomal abnormalities as well as low-risk chromosomal abnormalities, such as t(11;14)
- Dr. James R. Berenson’s study that used low-dose lenalidomide with ruxolitinib in patients with relapsed multiple myeloma—an out-of-the-box idea that suggests you can restore sensitivity to lenalidomide by combining it with a kinase inhibitor such as ruxolitinib. This type of combination has been used in other blood cancers but is just being studied in multiple myeloma.
- Follow-up data on at bb2121 CAR T-cell construct from Bluebird that is adding patients and showed a high-rate of disease control in patients with heavily pretreated multiple myeloma.
- Observations of the pembrolizumab + immunomodulatory agents in newly diagnosed and in relapsed multiple myeloma patients. These trials were halted a year ago due to an increased risk of death for the arms that used pembrolizumab. Dr. Costa learned that the nature of these deaths may have been due to immune-mediated toxicity and the use of such checkpoint inhibitors as pembrolizumab may be challenging in newly diagnosed myeloma patients.
ABOUT LUCIANO COSTA, MD
Luciano Costa, M.D., is an Associate Professor of Medicine Blood and Marrow Transplantation and Cell Therapy Program at the University of Alabama in Birmingham, Alabama. His main areas of focus include strategies for hematopoietic stem cell transplantation in chronic lymphoproliferative disorders, toxicity of hematopoietic stem cell transplantation, and population outcomes of hematologic malignancies. View Dr. Luciano Costa’s full biography here.