MULTIPLE MYELOMA

Outcomes in Newly Diagnosed Transplant-Ineligible Multiple Myeloma

The phase III BELLINI trial demonstrated translocation 11;14 and high BCL2 gene expression are predictive of response to treatment with the addition of venetoclax to bortezomib plus dexamethasone in patients with relapsed/refractory multiple myeloma, according to the findings presented at the 2019 ASH Annual Meeting.

A significant proportion of patients with transplant-ineligible newly diagnosed multiple myeloma alive and progression free after >3 years following treatment with daratumumab in addition to standard first-line therapy, according to updated safety and efficacy findings from the randomized ALCYONE study.

In the phase I CRB-402 study, patients with heavily pretreated relapsed/refractory multiple myeloma and minimal residual disease negativity had very good partial responses to the anti-BCMA CAR T cell therapy bb21217, according to updated results presented at the 2019 American Society of Hematology Annual Meeting.<br /> &nbsp;

&nbsp;In a&nbsp;<em>Targeted Oncology&nbsp;</em>case-based peer perspectives live discussion with a group of physicians, C. Ola Landgren, MD, PhD, reviewed several combination regimens used in the treatment of multiple myeloma. Landgren, chief of the Myeloma Service at Memorial Sloan Kettering Cancer Center in New York, used the case of a 51-year-old man with standard-risk disease to highlight the benefits and drawbacks of each therapy strategy.

Updated results of the GRIFFIN trial revealed that the addition of daratumumab to a standard-of-care regimen used in the treatment of newly diagnosed multiple myeloma met the trials primary end point of higher rates of stringent complete response in patients who are eligible for transplant.

In an interview with&nbsp;Targeted Oncology, Katja Weisel, MD, discussed the safety findings of the 4-drug chemotherapy regimen in the GMMG-CONCEPT trial, which were presented at the 17^th&nbsp;International Myeloma Workshop.

In the phase III CANDOR trial, the addition of daratumumab to carfilzomib and dexamethasone reduced the risk of disease progression or death by 37% compared with carfilzomib and dexamethasone alone in patients with relapsed/refractory multiple myeloma, according to findings from the phase III CANDOR trial presented at the 2019<br /> American Society of Hematology Annual Meeting.

Encouraging signs of dose-dependent efficacy, as well as a promising safety profile,&nbsp;were observed in patients&nbsp;with heavily pretreated relapsed/refractory multiple myeloma who were treated with&nbsp;CC-93269, a human IgG1-based T-cell engager that binds to BCMA and CD3 epsilon in a 2+1 format.

Patients with a difficult-to-treat form of multiple myeloma who were treated with a novel, bispecific anti-BCMA/anti-CD38 chimeric antigen receptor (CAR) T-cell therapy experienced promising responses and a manageable safety profile, according to results of a study that were presented at the 61st Annual American Society of Hematology Annual Meeting and Exposition.<br /> &nbsp;

In an interview with&nbsp;Targeted Oncology, Mark W. Bustoros, MD, discussed the findings from the study evaluating the genomic predictors of progression in patients with SMM and how these findings will impact treatment decisions for these patients in the future.

Marc J. Braunstein, MD, PhD, discusses the greatest challenge that still exists in the treatment paradigm of multiple myeloma.

Shaji Kumar, MD, discusses the shift in the treatment landscape for patients with multiple myeloma, and how more patients are eligible for stem cell transplantation because of new criteria.

There are at least two dozen different B-cell maturation antigen-directed therapies being explored in clinical trials, Sham Mailankody, MBBS, told attendees at the 37 Annual CFS.&nbsp;Mailankody, an assistant attending physician at Memorial Sloan Kettering Cancer Center in New York, New York, highlighted the most promising anti-BCMA agents across several modalities, including CAR T-cell therapy, bispecific antibodies, and antibody-drug conjugates.

There are many greatdebates in the field of multiple myeloma, and one that is becoming increasingly relevant in the era of modern therapies is whether or not to treat patients with asymptomatic disease. While the etiology of MM remains unknown, a major advancement in understanding myeloma pathogenesis has been the observation that all patientsprogress, albeit at differing rates, through an asymptomatic phase of either monoclonal gammopathy of undetermined significance or smoldering MM.

Pieter Sonneveld, MD, PhD, discusses how the findings from the phase III CASSIOPEIA trial inform current thinking about treating patients with multiple myeloma.

<br /> In the future, we&rsquo;re going to do combination therapies. They will be used in a subset of patients better defined by profiling,&rdquo; Kenneth C. Anderson, MD, told an audience at the Charlotte Plasma Cell Disorder Congress in North Carolina.

Successful induction regimens can reduce the burden of disease and prolong the durability of treatment response, time to disease progression, and overall survival for patients with newly diagnosed multiple myeloma, all while minimizing toxicity, according to Saad Usmani, MD, chief of the Plasma Cell Disorders Program and director of clinical research in hematologic malignancies at Levine Cancer Institute of the Carolinas Medical Center in Charlotte, North Carolina.

In September 2019, the FDA approved new treatment options for patients with endometrial carcinoma, prostate cancer, and multiple myeloma. The FDA also expanded the indication for the Cologuard noninvasive screening test for colorectal cancer. During the month there were 2 breakthrough therapy designations, 2 fast track designations, 1 orphan drug designation, and 1 priority review granted.

The discussion about the pros and cons of a 4-drug regimen for patients with multiple myeloma was highlighted during the 2019 Debates and Didactics in Hematology and Oncology conference.

The combination of daratumumab plus bortezomib, thalidomide, and dexamethasone (VTD) has been approved by the FDA for the treatment of newly diagnosed patients with multiple myeloma who are eligible for autologous stem cell transplant.

Selinexor plus lenalidomide and dexamethasone, an all-oral triplet, was found to be highly active in patients with relapsed or refractory multiple myeloma, according to results of the multi-arm STOMP study that were presented during the 17th International Myeloma Workshop. The regimen is also well tolerated and especially active in patients who did not receive lenalidomide prior to the trial.