Saturday night ended with a very successful IMF Media and Grant Awards Reception, at the Ultimate Skybox, with a 15th floor view of the Petco Park playing field on one side, and Seaport Village and the harbor on another.
Robert A. Kyle, MD, presented the Brian D. Novis Research Grant Awards. I was happy to have a conversation with him prior to the presentations, but I stopped short of asking for a second opinion!
The first part of the reception program was Living Well with Myeloma. Four long-term patients spoke about their experiences and gave messages of hope. The final speaker, Yelak Biru, was so spectacular that the City of San Diego inadvertently ‘provided’ a fireworks show in Seaport Village at the conclusion of his address.
On the scientific front, I made a few observations. Darzalex® (daratumumab) is getting the most attention of the newer drugs. It is said to be particularly good for frail patients or those not going to transplant, in combination with Revlimid® (lenalidomide) and dexamethasone, due to low toxicity. The same combination is also recommended for a first relapse, unless the patient is refractory to Revlimid. In that case, Darzalex with Velcade® (bortezomib), or Kyprolis® (carfilzomib), or Ninlaro® (ixazomib) and dexamethasone are recommended.
As many researchers continue to investigate the best applications of the drugs approved last year, others are looking at drugs that are not yet approved for myeloma. Venetoclax™, currently approved for chronic lymphocytic leukemia, is particularly effective for high-risk patients with the t(11:14) mutation, and is also being studied in combination with Velcade and dex for general use. Selinexor, with dex, is showing some activity in patients that are refractory to four or more prior treatments. Nelfinavir is an HIV drug being tested in proteasome-inhibitor refractory myeloma. Keytruda® (pembrolizumab), a PD-1 inhibitor approved for melanoma (yes, melanoma) and lung cancer, is another.
We’re all hoping that advancements in flow cytometry and genetic sequencing will lead to a day when any patient’s myeloma type can be easily identified and targeted with the exact proper treatment. At this time, I would say that some progress is being made, in that some treatments are proving to be more effective in “high-risk” patients, i. e., those with one of the well-known genetic mutations that are relatively common in myeloma.
And finally, I heard some skepticism that CAR-T therapy will be quick to mature. A significant issue is finding a target protein that is unique enough to myeloma cells. Hope is being held that B-cell maturation antigen (BCMA) is promising.