Now that the ASH Meeting is over, I can try to distill what I think of the current state of research in MM. While there are many exciting drugs under development and lots of clinical trials assessing various treatment options, the fact remains that many of these drugs are years away from coming online. From a patient's perspective, this is a little frustrating. The last major MM drug to be approved by the FDA was Revlimid in 2007. Only two others (carfilzomib and pomalidomide) are likely to be approved over the next couple of years. In the meantime, one can get access to these new drugs by participating in clinical trials. Fortunately for me, I am hoping not to need some of these new drugs in the short term, since my therapy is working quite well so far.
As for the transplant question, the jury is still out on the timing. With the success of the novel-agent drug therapies, trials are underway to determine whether ASCT should be performed early, as is now standard practice, or whether it makes sense to delay until first relapse. There seems to be consensus on a few points:
- Be as aggressive as possible in trying to contain the disease up front. Don't hold anything back in reserve for the next relapse
- ASCT is most effective either up front or after first relapse. After that, its effectiveness diminishes
- Achieving VGPR or CR before undergoing ASCT leads to much greater median Progression Free Survival (PFS) and Overall Survival (OS) and is a relevant objective for MM treatment
I found the last part of his blog regarding comments from Dr. Orlowski at that session to be memorable:
"Answering the oft asked question about whether new novel therapies will someday replace auto stem cell transplants, Dr. Orlowski responded with a qualified “yes.” Dr. Orlowski clearly believes SCTs will become a less important part of myeloma therapy someday.
“And when would that be?” a reporter asked. “Not until a number of these newer drugs become available in five or ten years.” he answered."
OK then. This is somewhat relevant to the decision I must shortly make. While there is reason to believe that with the successful novel-agent therapy I am now getting, I could decide to defer ASCT until my first relapse, there is still not enough data to validate that it would be the best approach. Decisions, decisions...
You may have noticed the time tag on this blog. Yes, it's 4:30 am! Don't ask me what I'm doing up at this hour. I have no idea myself. I can't blame it on the dexamethasone, since I haven't had that since Tuesday. I just woke up a while ago and decided to get up. My schedule has been a bit odd lately. I may go back to bed soon. Then again, I may not.