When I was diagnosed with myeloma in 2010, a huge concern of mine was the limited number of treatment options. Although the currently available options were far superior to those available just a decade prior, there was still a limited universe of treatment paths. I keenly remember one of my first visits to Vanderbilt Medical Center where my doctor said that lots of research was taking place and that the goal was to maximize the available options while we basically buy time until other options became available. He used the analogy of leap-frogging from one lily pad to another—once one treatment stops working, we will leap frog to the next option. Sensing the anxiety that I’m sure he could feel from my husband and me, he was very encouraging that the number of lily pads would increase. Moving forward just six years, the dilemma has transitioned to being overwhelmed by the number of treatment options. Clearly, this is terrific progress—progress which makes it even more important for patients and their physicians to be continually educated.
There is no better place to increase your knowledge of myeloma treatment options than at the American Society of Hematology (ASH) conference. The conference officially kicked off on Saturday, but Friday was reserved for symposia that offer medical professionals the opportunity to learn and earn continuing education credits. Various non-profits host learning opportunities for them to choose from. More than 1,000 physicians from around the world attended the International Myeloma Foundation’s (IMF) symposium aimed at educating local hematologists—most who don’t specialize in treating myeloma patients—about the treatments advances and how to translate them into practical use at the local treatment level.
Dr. Brian Durie, esteemed myeloma researcher and Chairman of the IMF, moderated a panel with five other myeloma experts who discussed four patient case studies ranging from treatment at diagnosis through relapse. The facts of each case were presented along with various treatment options to choose from. With each scenario, the audience electronically voted on how they would treat the patient. After the vote results were instantly tabulated and displayed on two huge screens in the packed ballroom, the option that each of the panelists elected was also displayed. Just as the opinions of the audience varied, the panel was not always unanimous in their theories on treatment. The panelists then presented the most up-to-date research related to each scenario that helped support the way they had voted on their treatment option of choice. Following each presentation, the audience voted again and it was revealed if their opinions changed.
A few highlights from the patient scenario discussions that caught my attention:
- The majority of the experts were recommending a tandem transplant for high-risk patients, although the majority of the audience did not vote for this option.
- Maintenance, also known as continuous therapy, was demonstrated to show an overall survival benefit in many patients, but the survival benefit was not as clear in high-risk patients.
- Best options at relapse include Revlimid® (lenalidomide)/dexamethasone plus a third agent such as Kyprolis® (carfilzomib), Ninlaro® (ixazomib), or Darzalex® (daratumumab).
To see the complete discussion, you can watch a replay of the entire session on the IMF’s website HERE.
You will see how much information is available, how much healthy debate there still is in the treatment of myeloma patients and become more educated so you can have an educated opinion to select the next lily pad that is right for you. Stay tuned for more information as the ASH conference unfolds!