Day 1: First full day of ASH
Saturday December 7, 2019
It’s nearly 11:00 p.m. as I begin to write my daily blog, but I’m still wide awake & enthusiastic, having just attended the IMF’s annual Brian D. Novis Research Grant Awards reception. After listening to some wonderful patient stories, I was encouraged to see five young researchers presented with monetary awards totaling $310K to fund 2 senior grants ($80K each) and 3 junior grants ($50K each) for their research in areas that will potentially benefit myeloma patients. It’s important to note that funds raised for these grants were from patients/caregivers/friends hosting various fundraising activities (e.g. 5Ks, an ocean swim, and more). And with over 150 grants given by the IMF in the past 21 years, 80% of those researchers are still focused on myeloma research. And did you know there are 150 multiple myeloma support groups around the country? Locate the one closest to you at the IMF website www.myeloma.org
The day started with a 7:30 a.m. Education session called “Challenges in Myeloma Therapy” led by Drs. Jonathan Kaufman (Winship at Emory University), Suzanne Lentzsch (Columbia University) and Elisabeth Manasanch (MD Anderson). Dr. Kaufman’s topic was “How I Treat a High-Risk Multiple Myeloma Patient” but spoke first about the definition of High-Risk and showed that some high-risk is higher high-risk than others. For example, with del 17p, the percentage of plasma cells is important, with a 55% of myeloma plasma cells being a critical number. But then, del 17p is worse—and when mutated between del 17p and p53—that’s the worst of all. Similarly, having multiple high-risk factors is worse than having only one. In treatment, most newer drugs work on high-risk patients, but not as well as on standard-risk patients. These days Emory favors Kyprolis, Revilmid and dex > stem cell tranplant > Kyprolis, Revlimid, and dex maintenance for many high-risk multiple myeloma patients.
Dr. Lentzsch addressed “How do I Treat Refractory Patients Not Eligible for a Clinical Trial.” Her patient was Rev-refractory, so she tried Daratumumab, Velcade, and dexamethasone (DaraVd), but the patient got neuropathy. While she considered a second transplant, it didn’t have strong support. So the patient was given elotuzumab, pomalidomide, and dex; and once the patient achieved a sustained response, she would try to eliminate one of the drugs.
Dr. Manasanch discussed “What to do with MRD Testing.” She compared different types of MRD but ultimately concluded that we do not yet have sufficient trial results for doctors to use MRD results to help guide treatment decisions.
Here are a few of today’s oral presentations (#Abstract Number):
Dr. Amrita Krishna (#140) provided early study results from Takeda (Velcade, Ninlaro) of a drug called TAK-079, an anti-CD-38 mAb (like Dara and Isatuximab). For N=34 pts with dosage varying from 45mg-1200mg, the final dosage will likely be either 300mg but more likely 600mg with overall response rates of 33% and 56% respectively, and 21% of these patients had prior Dara.
Dr. Christine Chen (#141) examined the all-oral treatment of selinixor, pomalide and dex for relapsed/refractory multiple myeloma and showed 56% overall response rate for N=51 pts averaging 4 lines of prior treatment and a median progression-free survival of 10.4 months for all patients.
Dr. Luciano Costa (#143) presented the first clinical study of a Celgene (now BMS) product CC-93269 that combines BCMA with a T-cell Engager. It’s a two-hour IV, and I believe has a mechanism similar to a Bi-Specific T-cell Engager. For N=12 getting >= 6mg, 89% achieved overall response rate with half of those achieve Complete Response/stringent Complete Response.
We had a Patient’s Partner Event Lunch with Celgene, the most interesting part to me being Celgene’s take on what it will be like being part of BMS. The companies seem complementary in product lines, and both appear to have a strong desire for patient advocacy.
Finally, another Education Program called Immunotherapy in Myeloma provided great summaries on CAR-T (Dr. Nina Shah, UCSF) and Next Generation Immunotherapy (Dr. Adam Cohen, UPenn). Dr. Shah listed CAR-T therapies focused on making CAR-T’s better by 1) Developing other targets (e,g, dual targets), 2) Better product composition (e.g. BB21217 improvement over BB2121), 3) Better cell engineering (e.g. “armored” or “on-switch”), 4) Timing of treatment (e.g. give earlier), and 5) Thinking “Inside” the box (better production).
And Dr. Cohen discussed checkpoint inhibitors for MM…”they’re not quite dead yet.” The Antibody Drug Congugate (ADC) from GSK…916 now has names Belantamab or Bentamal has gone through initial trial, DREAMM1 (overall response rate is 60%; median progression-free survival of 12 months). And now DREAMM2 demonstrates efficacy but may also cause thrombocytopenia as well as corneal side effects. Dr. Cohen also listed seven bi-specific antibodies under development.
Well that’s it for the day…oh yeah, the mishap. Better you hear it from me. The IMF arranges for a shuttle to get us from the hotel to convention center to pharma meetings, etc. And since I don’t walk well, they also rent me a scooter. I wanted to see the Immunotherapy session, indicating I would skip the shuttle and scooter to the restaurant via Google Maps. I put in the address, and it confidentially took me about 1.5 mi away to a place that didn’t exist (“You’ve arrived!” my phone exclaimed). I had been given the wrong address, but by that time for scooter and phone batteries were low. Fortunately, the phone had enough juice and the shuttle found me and picked me up. I’m sure this will be one of our many ASH stories retold and embellished…which is ok to do when everything ends well.
Wishing best of health!
— Jack Aiello, on Twitter @JackMAiello