Addressing Current Questions and Controversies

Addressing Current Questions and Controversies

Dec 7, 2024 | Linda Huguelet

Friday evening (Eastern time), I attended one of the best symposiums I’ve seen in my 12 years of attending the American Society of Hematology (ASH) Annual Meeting. Sagar Lonial, MD moderated a panel of elite myeloma specialists through five modules of discussion. The panel included Professor Philippe Moreau, MD; Robert Z Orlowski, MD, PhD; Noopur Raje, MD; Paul G. Richardson, MD. The discussion also included real-world clinical questions from six community-based hematologists.
The Modules ran the spectrum from newly diagnosed to what the future holds. The modules were Management of Newly Diagnosed Multiple Myeloma (MM), Integration of Novel Therapies into the Management of Relapsed/Refractory MM, Chimeric Antigen Receptor (CAR) T-Cell Therapy for MM, Bispecific Antibodies for the Treatment of MM, and Other Novel Agents and Strategies Under Investigation for MM.

Each panelist led one of the modules which sparked good conversation and sometimes debate among the group. I can’t include all the items that caught my attention from the two-hour event, but a few key takeaways for me included:

  • Quad therapies of Darzalex (daratumumab), Revlimid (lenalidomide), Velcade (bortezomib), and dexamethasone; or Sarclisa (isatuximab), Revlimid (lenalidomide), Velcade (bortezomib), and dexamethasone definitely show benefit and no need to avoid adding the monoclonal antibody to the tried and true Revlimid, Velcade, dex induction therapy. They produce increased response and increased minimal residual disease (MRD) negativity.
  • The use of autologous stem cell transplant (ASCT) did not have 100% endorsement from the panelists. Drs. Lonial, Moreau, and Raje continue to see value, while Dr. Orlowski did not favor using it upfront and Dr. Richardson was undecided. What does the future hold for ASCT? Will CAR T-cell therapy take its place in the future? I’ll be listening closely in the abstracts for more information on this topic.
  • The use of Xpovio (Selinexor) got favorable reviews from the panel when it was used at lower doses than originally prescribed. Its unique mechanism of action provides a new way to attack myeloma. I used this drug as part of my bridging therapy before my CAR T-cell therapy in 2023. I was wisely advised by the late Jack Aiello on the dosage—which concurs with what was presented in the symposium, and I had a very positive experience with this treatment.
  • There was consensus that PET/CT is advised post-CAR T-cell therapy to monitor for extramedullary disease. I questioned the need for this in my last visit with Dr. Lonial and this reason, which was also confirmed by my local hematologist, convinced me of the true need. I have this scheduled for two weeks from now.
  • Blenrep (belantamab mafodotin)—the antibody drug conjugate—will be back in the arsenal of FDA-approved treatments. I’ll be looking for additional data from the DREAMM 7 and DREAMM 8 studies over the next couple of days. Given at reduced dosing and spread out over as much as 8-12 weeks, this is showing efficacy without the previously reported difficult ocular side effects.
  • Iberdomide and Mezigdomide, which are advances of immunomodulatory agents like Revlimid and Pomalyst, show great promise. There was a discussion that they may even replace Revlimid in the induction therapy regimen in the future.

I’m excited to get started in the Annual Meeting which starts virtually for me this afternoon. Please check out the blogs and tweets on Twitter (X) of the entire ASH 24 team throughout the conference to stay up-to-date on all the promising advancements.

Linda Huguelet, Chattanooga Multiple Myeloma Networking Group

@LindaMYELOMA

In a Sea of Healthcare Professionals, A Small School of Patient Voices

In a Sea of Healthcare Professionals, A Small School of Patient Voices

Dec 7, 2024 | Jenn Wieworka

Walking the hallways of the San Diego Convention Center Friday morning, scoping our path for the upcoming 66th American Society of Hematology Annual Meeting, I was told, “Get ready, because tomorrow we’re going to be like fishes swimming upstream.” I can’t help but think how that metaphorically represents our group in so many ways.

Physically, this weekend, ASH will be attended by over 30,000 healthcare professionals—including academic myeloma specialists, community oncologists, scientists, pharmacists, nurses, and learners. Then also, less than 1% of those here will be patients and care partners—individuals not directly working in the field but passionate about the progress it makes. A small but mighty group that wants to take the information shared and spread the good news.

Cognitively, the International Myeloma Foundation has been swimming upstream, challenging medical norms to ensure that the patient’s voice is heard. We’ve been bringing a team of support group leaders for almost 20 years and are happy now to see our friends and other patient advocates coming. CoMMunally, different organizations, pharmaceutical companies, and providers are working to amplify the patient voice. I hope to focus on the quality-of-life impacts, inclusion efforts, and real-world data during ASH this year.

As a collective, we all will leave ASH more eMMpowered, educated, and enlightened. As a nurse, I’ve been to medical conferences before, always leaving feeling ready to make big changes in cancer care; as IMF Director of Support Groups, coming to ASH with the myeloma Voices Team my head is spinning with ideas before we even start; my heart pounding ready to work with our amazing team to strengthen our leaders’ voices so that tomorrow we can have a world where every myeloma patient can live life to the fullest, unburdened by the disease.

Jenn Wieworka DNP, RN, OCN (She/Her)
Director, IMF Support Groups
X @jwiework
@jwiew.bsky.social

Many Unique Data Points on the Myeloma Treatment Landscape

Many Unique Data Points on the Myeloma Treatment Landscape

Dec 7, 2024 | Jill Zitzewitz

Friday is Satellite Symposia Day! It’s the day before the official meeting starts, when industry partners sponsor continuing medical education sessions for community treating physicians. I attended not 1, or 2, or even 3, but 4 of these sessions! I couldn’t resist. All the rockstars of the multiple myeloma world were presenting summaries of the latest treatment best practices. There are so many new clinical trials and recently FDA-approved myeloma therapies that are transforming outcomes for patients! The talks were interspersed with discussions, clinical cases, and quizzes on treatment options for the clinician audience. I was pleasantly surprised that I was able to answer nearly all the questions correctly! Being a patient advocate has taught me a lot, and it probably doesn’t hurt that I teach graduate and medical students at the academic medical center where I get my care.

The common organizational structure of each of these symposia was to divide the talks by disease status, including discussions of newly diagnosed multiple myeloma (both transplant eligible or ineligible), first relapse, and then successive relapses in relapsed refractory myeloma (RRMM). There is often an image where myeloma disease status is plotted as a function of time, showing how patients respond to treatment in each line of therapy. It ends up looking a bit like a mountain range, and as a scientist, I love these plots. I studied protein folding throughout my career, and I made a lot of figures that looked quite similar. For fun, I took the liberty of adding myself as a data point to an image that was presented in the first session that I attended called “Bridging Gaps in Multiple Myeloma Care: A Community Oncologist’s Guide to Navigating the Evolving Treatment Landscape.” In this session, led by Drs. Caitlin Costello, MD; and Rahul Banerjee, MD, FACP; I learned that anti-CD38+ antibodies are the treating oncologist’s friend because they deepen the depth and length of response. It got me thinking about how I’ve been on my second line of therapy, Darzalex (daratumumab), Pomalyst (pomalidomide) and dexamethasone – DPd, for nearly 4 years now. I had my first relapse about 2 years after my stem cell transplant, but quad therapies were not even an option then. Who knows how long it will be before I need a third line of therapy? I’m sitting happily in that long break of time on the plot between relapses, enjoying every day!

The common theme for all of today’s sessions was that each patient is a unique case. Now that there are so many new therapies in the myeloma tool kit that have been FDA-approved, we are learning a lot about how they perform in the real world, with patients who wouldn’t have qualified for a clinical trial because of comorbidities or other challenges. It was encouraging to see that patient preferences and lifestyle choices are playing a key role in deciding next therapies, along with disease status and side-effect and treatment management. Additionally, each of today’s sessions also focused on unmet needs in access to care and how community oncologists can partner with myeloma specialists at academic medical centers to ensure that each patient gets the care that is right for them. It was encouraging to hear discussions of shared decision-making, fostering inclusiveness, and supporting patients’ priorities for their lives. Indeed, each myeloma patient is a unique data point on the evolving myeloma treatment landscape, and I find it so hopeful that we’re learning so much how to implement the right treatment option for each unique patient at different points in time so that they can enjoy a high quality of life.

Jill Zitzewitz, PhD, Central MA Multiple Myeloma Support Group
Follow me on X @JillZitzewitz