IMF Satellite Seminar Best ASH Session by qpv40869


									      IMF Satellite Seminar
           Best ASH Session

A new patient saw two Johns Hopkins
doctors in 2008; both told her to get her
affairs in order.

She found the IMF, then Dr Hayman at
Mayo Clinic, and she seemed strong at
ASH. She’s not dying anytime soon.

This session was about current standards
of treatment, for practicing doctors.
Dr Vincent Rajkumar, Mayo Clinic

P With immunofixation (IFIX, IgG & IgA),
  serum protein electrophoresis (SPEP, M-
  spike), and free light chain analysis (FLC)
  we have the tools to detect myeloma.
  May need them all.
P With FISH and other cytogenetic studies
  we can evaluate risk factors.
P MGUS => 1% per year symptomatic
  myeloma. SMM => 10% per year.
        Rajkumar, continued

P C.R.A.B. (Calcium, renal, anemia, bone)
  symptoms define active myeloma, Stage I
  at least.
P Dr Rajkumar thinks that unexplained
  neuropathy can also signal active
  myeloma and maybe should be added to
  the CRAB criteria.

P CR = Complete Response. No M-spike and
  < 5% plasma cells in bone marrow biopsy.
P VGPR = Very Good Partial Response, 90%
  reduction in serum M-spike and < 100 mg M-
  protein per 24 hr urine.
P PR = Partial Response, 50% reduction in
  serum M-spike and < 200 mg M-protein per
  24 hr urine.
          Terms, Continued:

P PD = Progressive Disease, 25% increase in
  M-spike over lowest value, plus worsening of
  at least one C.R.A.B. symptom.
P SD = Stable Disease, does not meet any of
  the above criteria.
P ASCT = Autologous Stem Cell Transplant.
    Dr Phillippe Moreau, Nantes
Treatment, Newly Diagnosed Patients < 65

P Audience of hematologists polled. 75%
  thought that ASCT is the “standard of
  care” for newly-diagnosed patients.
P Use novel drug combos first because:
 < They don’t interfere with stem cell collection,
 < Getting CR or VGPR is important to ASCT
P But if CR or VGPR achieved, proceed with
  ASCT anyway? Panelists were divided.
         Moreau, continued

P Consolidation is a drug regimen after
  transplant or multi-drug regimen that
  brings patient to CR or VGPR.
P Maintenance is a continuing drug
  regimen to maintain a good response.
  Dr Mario Boccadoro, Turin Italy
     Newly Diagnosed 65 and Older
P Two thirds of all myelomiacs are 65 or
P In USA we do not have a hard cutoff at
  age 65 where treatment regimen changes.
P Every Boccadoro regimen contained
  melphalan or another alkylating agent.
P In one study, the control group survived
  longer than the study group. !?!
Dr Robert Orlowski, MD Anderson,
      Relapsed & Refractory Patients

P (1) Try something that has worked before;
P (2) Then Velcade alone or with DEX;
P (3) Then Velcade with Doxil; and finally
P (4) Velcade & Doxil w DEX or even an
  alkylating agent.

P He is studying carfilzomib and likes it a
       Velcade and Peripheral
          Neuropathy (PN)
         Make the Pain Go Away

P Grade 1 & 2 PN are not disabling.
P Grade 3 is disabling, Grade 4 is
P Doctors are becoming more aware of
  quality of life issues and especially PN.
P As many as 50% of patients eventually get
  to Grade 3 or 4 on Velcade, especially
  with thalidomide.
      Velcade & PN, continued
P Three ways to reduce that, eventually:
P RIGHT NOW the regimen can be reduced
  from twice weekly to once weekly.
 < Helps a LOT.
 < May require more cycles to get to CR or VGPR.
 < May be the standard of care at Mayo
   Rochester already.
P Hopefully soon: Tanespimycin, in Phase
  III “clinical development,” prevents much
  of Velcade’s toxicity. Bristol-Myers
  Squibb is pushing hard - lots of hype.
  Velcade & PN, continued again

P Hopefully sooner: Carfilzomib is claimed
  to be better than Velcade in every way:
 < Almost no PN.
 < May work for people whose myeloma is
   resistant to Velcade.
 < Some doctors are a little skeptical.
 < May be approved by end of 2010.

 < It is indeed named after Carla and Phil.
       Humanized Monoclonal
   Antibodies bind to antigens to cause cell death

P Antibodies are like IgG and IgA - part of
  the immune system.
P Humanized means safe for use in
P Monoclonal means the antibodies are all
  exactly the same.
P Drug names end in “-mab”
    Humanized MAB, continued

P Binds to CS1, a cell protein specific to
  myeloma cells.
P Phase I and II trials are looking very good.
P Testing with Velcade and Revlimid.
P This is a very promising field, with several
  other MABs in the works, by several
  different drug companies.

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