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Sunday, December 13, 2015

Patient Education Symposium

I spent yesterday at the Farber's Multiple Myeloma Patient Education Symposium.  As usual, it was a fascinating, informative day, which incorporated the latest results from the recent ASH conference in Orlando.  The mood in the MM research and clinical community is ebullient these days.  It has been a banner year for MM advances.  There have been 7 FDA approvals for novel MM therapies this year alone, 3 in the last month!  The total arsenal of available novel drugs to treat this disease has just expanded by 45%.  No wonder everyone is really excited.  There was a palpable buzz of energy and excitement in the room, more so than in previous years.  it was really encouraging to feel the sense of optimism about where things are headed.

Of all the presentations of the day, Ken Anderson's was the pi├Ęce de r├ęsistance.  I would have made the trip to Boston just to hear him speak.  He has a way of presenting complex facts in a down-to-earth way that makes sense to ordinary people (not so with some of the other presenters).  He's also a great public speaker with a wonderful sense of humor that keeps the audience fully engaged.  He also shared an uplifting vision of where MM research is headed and some of the exciting new therapies on the horizon.  When he finished, he got a prolonged standing ovation, something that I've never seen at one of these meetings before.  Videos of this meeting will be available on YouTube in January.  I'll try to post a link to Ken's talk for any of you who might be interested.  It was amazing!

I'm not going to delve into some of the boring details of the meeting, but I'll try to give a top-level overview of my impressions.  I've had to spend a day sorting it out, because some of it was like trying to drink out of a fire hose.  Here are a few of my general observations:

There is a lot of focus now on the precursor conditions to MM:  MGUS and Smoldering Myeloma (SMM).  The thinking now is that by intervening earlier, not only may some of the bone and organ damage of MM be averted, but perhaps it can be better controlled or (gasp!) cured before full-fledged MM emerges.  Some high-risk SM patients are now being classified as MM and eligible for full therapy options.  There are also clinical trials underway to investigate use of experimental vaccines in SMM patients to help prevent progression to full MM.  This trend is likely to continue.

Long-term clinical trial results are starting to show that with the efficacy of the new novel therapies for newly-diagnosed MM patients, there may be no advantage to doing an early stem cell transplant.  French and American studies differ, but the American study shows that if Revlimid maintenance is continued indefinitely after induction therapy, deferring a stem cell transplant until after relapse may actually be better.  This could eventually result in a change in the current standard of treatment therapy, which now encourages an early transplant.  However, this would go against the Total Therapy approach (Arkansas), which advocates high-dose chemo and early tandem transplants in the expectation of a complete cure for normal risk patients.  Let's just see how this all plays out.

They are very excited about the approval for Ixazumib (MLN9708).  Me too!  It worked great for me.  In addition to being somewhat superior to Velcade, both in response and side effects, having a totally oral regimen is a major plus in terms of convenience for patients.  Aside from the potential insurance coverage difficulties that I posted about earlier, this could be a game changer for MM therapy.

Immunotherapy is the name of the game for the future.  Whether it is the expanded use of immunomodulator agents, (Revlimid, Pomalyst), monoclonal antibodies (Dararatumumab, Elotuzumab, SAR650984), checkpoint inhibitors (PD1-PDL1 blockades), or vaccines, that's where the game is going.  Vaccines are a particularly hot topic.  There are several ways in which vaccines can be employed, some of which involve extracting MM cells from the blood, fusing them with an antigen, and then injecting them back into the patient.  There are several clinical trials planned or underway, and I would expect to see a lot of developing news on that front in the next year or so.

While I was there, I ran into a couple of fellow patients that I had met before.  Paul and I had met a couple of years ago at the Farber, and he continues to follow my blog.  Fortunately, he is still doing well.  I also ran into Dee, with whom I have had previous discussions regarding the association of Lyme Disease with MM.  We both feel that there is a positive link that Lyme may be a precursor to MM.  I hope to communicate more with her and update some of those discussions in the near future

It was a good day.  Until next time.