Dec 17, 2024 | Jim Shoemaker
Monday, December 16. Seven days ago, I was in meetings in San Diego overwhelmed and overloaded with information. My experience at ASH in San Diego is difficult to explain. I had the privilege to make “New Friends” and renew relationships with “Old Friends,” and it doesn’t get any better than that. The experience at ASH remains an amazing and unforgettable event, and I do not take that for granted. Each team member of the IMF contributed to a wonderful experience, and we were all blessed. I owe much thanks to the IMF for making it all possible.
I attended Dr. Sonja Zweegman’s presentation and was fascinated by the work her research group is doing with frail patients. It is a long-term follow-up of the HOVON 143 Trial. This is my best attempt to summarize with you what I learned:
The long-term follow-up of the HOVON 143 study, which involved frail patients with multiple myeloma, assessed the impact of treatment with Ninlaro (ixazomib), Darzalex (daratumumab), and low-dose dexamethasone. The study included 65 frail patients (ages 70 to 92), and after a median follow-up of 61.5 months, the median overall survival was 34.0 months, with median progression-free survival (PFS) of 13.8 months. The study also identified distinct frailty subgroups: patients who were frail based on age alone, those who were considered frail due to impairments, and ultra-frail patients with both age and impairment factors. Ultra-frail patients had worse outcomes. In contrast, patients who were frail based only on age showed better survival outcomes and were more likely to receive second-line treatment, which led to longer disease suppression.
These findings emphasize the need for more tolerable and effective therapies for frail patients, particularly those classified as ultra-frail. The study suggests that frail patients based on age alone could benefit from more intensive first-line treatments.
So much information! But the best takeaway for me, as I listened to one presentation after another: there are several prospective new therapies. I was diagnosed 17 years ago and at the time there was not much on the shelf for treatment. I am grateful for the research teams, the medical teams, pharmaceutical companies, and most of all—for the IMF.
Dec 12, 2024 | Terry Glassman
I am traveling today and then a very busy treatment day, so I’m going to do a quick post-ASH blog. Yet, if you want to hear more in-depth, check back because I promise another blog within a week.
First off, one of my fellow patients who follows me asked, “it must be hard listening to all this information.” Honestly, it was not; it was encouraging and hopeful. As I’ve mentioned before, my Myeloma Specialist told me on my first visit; “The longer I keep you alive, the longer I can keep you alive.” That sentiment stayed with me throughout ASH. It was palpable as I listened to the latest research and advances in treatment…hopeful progress everywhere!
It was heartening to see how dedicated these physicians and scientists are. So many brilliant minds sharing, questioning, and learning from each other! Sure, at times I felt like they were talking about me and us, but I’ve long come to terms with the reality of living with a serious disease. I follow that up with: I have these incredibly serious people working on controlling, and ultimately, curing it! That gives me hope, and that’s what keeps me going.
I’d also like to reiterate another mantra of mine here; see a Multiple Myeloma (MM) Specialist—it really matters!
Okay, Days 2 & 3 Quick Synopsis
Dara, Dara, Dara, Isa!
It is a big deal when a treatment changes the standard of care, and the anti-CD38 antibodies have done just that! Quadruplet therapy as a standard of care in induction therapy has shown amazing results! Even more exciting? Darzalex (daratumumab) has also been shown to prolong progression-free survival (PFS) when used in maintenance therapy. But…wait…there’s more!
Dara is showing incredible promise in high-risk smoldering multiple myeloma (HR SMM). And although Dara took up a lot of space, Sarclisa (isatuximab) showed promising results in induction therapy as well! Isa “might” change the microenvironment, which “might” slow down the rate of progression. It will be interesting to see if this theory plays out and how it plays out!
Next up: Bispecific Antibodies!
Tecvayli (teclistamab) took the center stage in a phase two study, showing promise in induction therapy as both a safe and highly effective treatment. On to phase 3, but it looks very promising. All evaluable patients achieved Minimal Residual Disease (MRD) negativity during maintenance. Patient note: Here’s where the hope keeps sneaking back in!!
Teclistamab is also being looked at in maintenance therapy and early results are positive as well as relapsed/refractory multiple myeloma (RRMM). Elrexfio (elranatamab), Kyprolis (carfilzomib) with dexamethasone are being studied as well.
SO much in the pipeline for Bispecific Antibodies! AND…as if that weren’t enough a bispecific antibody with a new target, Cevostamab is being studied in a phase one clinical trial in heavily pretreated patients and has shown meaningful activity and manageable safety in this patient population at the 160mg TD level given once every 3 weeks.
Studies with Talvey (talquetamab) and Blenrep (belantamab mafodotin) are also showing promise. Though they are sometimes considered harder to tolerate due to the negative side effects, there’s good news here: With adjustments in timing and dosage, these treatments are still effective in managing disease while keeping side effects under control.
New on the scene is Etentamig (also known as ABBV-383), a monthly dosed bispecific antibody. Early studies are promising, and it’s definitely one to watch. I personally was intrigued by its binding domain and its potential to mitigate cytokine release syndrome (CRS) More to come!
Smoldering Multiple Myeloma (SMM): New Hope on the Horizon
When a person has smoldering multiple myeloma and their myeloma is growing, doctors often consider this a “watch and wait” situation. This can be stressful and anxiety-inducing for patients, but the AQUILA study offers hope. It shows that treatment with Dara can extend time before active treatment is required in the high-risk SMM population.
Frailty
Research was presented that looked into the following: reduced dosing, decreased dexamethasone, and clinical trials including older patients. More to come on that, but I will say Darzalex (daratumumab), Revlimid (lenalidomide), or DR outperformed Revilimid (Lenalidomide) and dexamethasone (Rd) in the frail population…down with Dex!!
I’ll stop here for now with the promise to return and further clarify. I hope to share more information once I stop long enough to look at my notes and absorb the immense amount of information I took in over the past three to four days! This is by NO MEANS a comprehensive review; it’s just what caught my attention. Again, I remind all who are reading, this is the takeaway from me…a humble fellow MM patient, and it is how I personally understood the information presented! I hope it gives you a good starting point to delve deeper into the information yourself and discuss what you find with your care team.
It’s exciting to see all this research across the spectrum of treatment lines. It is a non-ending quest for better, safer, and more effective treatment of MM. I was humbled and honored to be a part of the IMF team, and this nerd can’t wait to look at a few of the presentations I did not get to attend! I did have a focus on High-Risk Multiple Myeloma (HRMM), but I did not find much discussion on this. Yet, many studies did include high-risk patients. I will delve deeper in the coming days and share what I find.
That’s it for now! I’ll be back soon with a more detailed post on what I’ve learned from ASH. Thanks for following along and remember: There is always hope! Stay strong, keep fighting, and always reach out to your specialist and team with any questions you may have! They are working every day for us!
HOPE
Hardworking MM specialists and oncologists.
Optimism SO much research for newly diagnosed and those exposed to many lines.
Patients…the center of it all!
Energy! That is what I saw most at ASH an uncontainable energy to do more, know more, help more!
