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ASH 2018: Best Kept Secret at ASH in Multiple Myeloma
ASH 2018: Best Kept Secret at ASH in Multiple Myeloma image
ASH 2018: Best Kept Secret at ASH in Multiple Myeloma
Posted Dec 14, 2018

I believe this might be the best kept secret at ASH 2018.

Abstract 801 - Carfilzomib, Pomalidomide and Dexamethasone (KPd) in Patients with Multiple Myeloma Refractory to Bortezomib and Lenalidomide. the EMN011 Trial
 
Pieter Sonneveld, Professor of Hematology and head of the Department of Hematology at the Erasmus MC Cancer Institute and Professor of Hematology at the Erasmus University of Rotterdam, The Netherlands presented the early findings of the study.  This Phase 2 trial was designed for patients with refractory disease or first progression in order to evaluate a salvage treatment with next generation proteasome inhibition and immunomodulators, i.e., Carfilzomib, Pomalidomide and Dexamethasone. The primary endpoints were response and progression-free survival (PFS).
 
As can be seen from the following graph, Median Overall survival had not been reached at 24 months.
 

 
The results of this trial are listed below with the end points being reached, at a overall response rate ORR of 87%, and Median progression free survival PFS of 18 months.
 
Why might this be the best kept secret? Well, if I look at overall response rates on other myeloma relapsed/refractory studies, 87% is a class leader.  
 
I am aware it is frowned on to look at data between studies, however many people do (and I will), but only as a means to identify trends.  I conducted a search of salvage therapies for relapsed/refractory myeloma and the following is a sample of the overall response rate in a small sample of them.  But what can be seen is the PKd regimen with a ORR of 87% is directionally exceptional! Here are some of the other studies: 
  • Phase I Trial of Anti-CS1 Monoclonal Antibody Elotuzumab in Combination With Bortezomib in the Treatment of Relapsed/Refractory Multiple Myeloma - ORR of 48%
  • Pomalidomide alone or in combination with low-dose dexamethasone in relapsed and refractory multiple myeloma: a randomized phase 2 study - ORR of 33%
  • Daratumumab monotherapy in patients with treatment-refractory multiple myeloma (SIRIUS): an open-label, randomised, phase 2 trial - ORR of 29.2%
  • Combination of bendamustine, lenalidomide, and dexamethasone (BLD) in patients with relapsed or refractory multiple myeloma is feasible and highly effective: results of phase I/II open-label, dose escalation study - ORR of 52%
  • PANORAMA 2: panobinostat in combination with bortezomib and dexamethasone in patients with relapsed and bortezomib-refractory myeloma - ORR of 34%

Upcoming immunotherapies such as CAR T, bITEs and others are seeing response rates in the 80-90% but for these classes of drugs, this study is showing exceptional results. 

The author Gary Petersen

about the author
Gary Petersen

Gary is a myeloma survivor and patient advocate. His work centers around helping patients live longer by helping them to find facilities who are beating the average survival statistics. You can find Gary's site at www.myelomasurvival.com and follow him on Twitter at @grpetersen1

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