2020 Shaping Up To Be Big Year for Multiple Myeloma Treatment
Dr. Sikander Ailawadhi of Mayo Clinic provides high-level highlights for multiple myeloma from the 61st American Society of Hematology (ASH) Meeting in Orlando, Florida.
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Dr. Ailawadhi, your studies have been getting a lot of attention. What do you feel are the highlights for myeloma patients and families?
Dr. Sikander Ailawadhi:
There has been a lot of new news – updated information coming out of this ASH meeting in Orlando in 2019. We know that the treatment of myeloma depends on using the right kind of treatment for the right duration of time and what we’re learning now is if that if the right combination is used and it is used for that good length of time patients can get an extremely deep response.
The term that patients and caregivers would’ve heard called MRD (minimal residual disease). As long as the right kind of treatment is used this MRD (minimal residual disease) is fast becoming the benchmark of what a good regimen should be. This is still not being used by the federal authorities; the FDA for example for approving drugs. But all of us in the myeloma community are realizing that if a regimen or a drug can eliminate the disease that fast hopefully it can provide longer durations of response.
So, in that theme some regimens are coming up with even four drugs for newly diagnosed patients or multiple regimens even including new ones – some combinations and some even individual new immunotherapy drugs which are leading to this very deep response in heavily pre-treated patients.
One of the themes that has come out is this target called the BCMA (B-cell maturation antigen) that is present in myeloma cells, almost universally in myeloma cells. So, a lot of drugs, lots of immunotherapy including what patients may have heard about CAR T-cells, antibody drug conjugates, bispecific or BiTE antibodies etc. So, a lot of these strategies trying to target that one marker present in myeloma cells.
What we have heard is that in this same setting of immunotherapy there is longer data of good response with CAR T-cells for example. There is more data that came out about the bispecific or BiTE antibodies. We also found some very interesting information about patients who may have been treated with this drug called for example Daratumumab (DARZALEX). Daratumumab (DARZALEX) is a drug, immunotherapy drug that goes against the marker CD38. Now we are seeing subsequent other drugs in the same landscape coming out which are showing that you can attack that marker, the CD38 again and again.
In the past the thought was that once if the patient was treated by a drug that targets one particular marker that whole pathway or that mechanism of action is gone, but there was data presented at ASH, which we are all very encouraged about. Patients who have let’s say have been treated with Daratumumab (DARZALEX) so one drug affecting that pathway – when they had disease progression at some point they were treated with a brand-new drug going on in for that pathway and the patients got very good deep responses.
The same MRD (minimal residual disease) was cleared in some cases within a month so that tells us that we attack the same pathway again. That is a huge news for us because we don’t want to be in a situation that we have four or five drugs using a pathway or exploiting myeloma based on a pathway and the patient can only get one of them so that is a –-that would be a concern. We think that 2020 is going to be another big year for multiple myeloma treatment because we expect maybe two to three hopefully around that many new drugs to be approved in the myeloma treatment field.
Majority of these will be in fact –- we think most of them will be for patients who have been previously treated, but if you can imagine the theme is earlier effective treatment for a deep response to keep the disease quiet and when the disease comes back using strategies that can eliminate the disease all over again using these new immunotherapy targets, so that we can keep the disease quiet for a very long period of time.
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