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Sunday, December 9, 2012

ASH Meeting -Part 1

I ambitiously titled this post as "Part 1", which puts me on the hook for following up with at least a Part 2, if not more.  What pressure I put on myself!

Anyway, in my last post, I reported on the recent audio teleconference on the Cure Panel Talk Show with Dr. Berenson, where he articulated his "less is more" and "do no harm" approach to treating MM.  Tonight, I watched a video webcast of a live conference from the American Society of Hematology (ASH) meeting, which is ongoing this weekend in Atlanta, Georgia.  The webcast was sponsored by the International Myeloma Foundation (IMF).  I was particularly interested in this, as one of the panelists was Dr. Richardson, and it also included Dr. Durie of the IMF, Dr. Leleu from France, and Dr. Orlowski from the MD Anderson Center in Texas.

Richardson spoke first.  His philosophy is 180 degrees opposed to that of Dr. Berenson.  It's a wonder they don't come to fisticuffs whenever they cross paths!  I'd love to see them debate.  Richardson strongly advanced the position that there is "no role for keeping the best drugs in reserve", because it is "most likely to make progress against MM early rather than late".  Furthermore, in discussing global trends, his approach is to "get the snake in the basket and then sit on it".  He likens long-term maintenance as the mongoose sitting on the basket trapping the MM python within.  Strikingly vivid metaphors, huh?  I have an image of that repressed python struggling within me, and I'm now taking 5 mg of the mongoose (Revlimid) daily to sit on that basket.

There is a lot of other exciting news coming out of ASH.  There are a number of papers on Kyprolis (carfilzomib) and pomalidomide, showing excellent results from both.  Kyprolis seems to work at least as well, if not better than Velcade without the PN side effects, while pomolidomide may even be more effective than Revlimid with less neutropenia.  This is great news!  When that day comes when I relapse (and I know the snake will get out sometime), it's comforting to know that there are even better therapies at hand than the ones that worked so well for me the first time.  In addition, a paper by Durie shows that a regimen of Kyprolis/pomalidomide/dex not only gives excellent response for relapsed/refractory MM patients, but seems to work as well for high-risk patients as well as for low-risk patients.  That was music to my ears.

There are a bunch of other new promising drugs undergoing trials.  The Phase 2 MLN9708 trials seem to be going very well, with an Overall Response rate (OR) of 88%.  I'm glad I had a chance to get in on Phase 1 of that clinical trial.  Other exciting results are being reported for the monoclonal antibodies, elotuzumab and daratumumab (those roll off the tongue almost as easily as Rosencrantz and Guildenstern).  Promising clinical trial results are also being reported for Vorinostat, an HDAC inhibitor, and ARRY-520, an KSP inhibitor.  I don't know what the acronyms stand for that these drugs are inhibiting, but if the MM cells don't like them being inhibited, then I'm all for it.

There are other interesting drug results to report on from ASH, but I'd better stop now, or else I might not have anything useful to discuss in Part 2, or (gulp) even Part 3 of this series.

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