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Latest in relapsed and refractory multiple myeloma

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Published: 25.06.17
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Prof Heinz Ludwig, Prof Wee Joo Chng and Prof James Chim

Professor Heinz Ludwig (Wilhelminenspital, Center for Oncology and Hematology, Vienna, Austria) is joined by Professor Wee Joo Chng (National University Cancer Institute, Singapore) and Professor James Chim (Queen Mary Hospital, University of Hong Kong, Hong Kong), to discuss the latest progress in relapsed and refractory multiple myeloma (RRMM).

Recent trials investigating combination therapies in RRMM were discussed such as ASPIRE, ENDEAVOUR and TOURMALINE-MM1.

Trials such as these have brought about various approvals for new treatments in RRMM, with Professor Chng noting how in Singapore this has led to ‘a lot of choices for physicians and a lot of hope for patients’.

However, it is highlighted that challenges remain for physicians over how to use these drugs (due to a lack of head to head comparisons) and for patients over how to access them. 

Professor Chim confirms this latter point, citing a lack of clinical trial experience and pricing issues in Hong Kong as barriers to patient access.

Professor Chng provided detail around the TOURMALINE-MM1 study of the oral proteasome inhibitor ixazomib, which showed superior PFS with ixazomib plus lenalidomide and dexamethasone (Rd) verses Rd.

It was noted how similar responses were seen in high-risk patients to standard risk patients, however questions remain over the ease of access for patients to receive this therapy.

Finding other suitable combinations could be a potential solution, with Professor Ludwig discussing results of a trial looking at ixazomib plus thalidomide and dexamethasone.

The large Chinese extension study has been able to confirm results seen in TOURMALINE-MM1, leading Prof Ludwig to suggest that ixazomib will now be implemented in different protocols.

Professor Chim highlights positive results recently seen with daratumumab in the POLLUX study, showing response rates of 90% that could be attributed to an expanded mechanism of action.

The importance of immuno-therapy was discussed, with promising new data presented at EHA evaluating the use of pembrolizumab plus Rd in RRMM. 

The panel then discuss results looking at CAR T-Cell therapy, presented by the Chinese Group at ASCO and EHA and noting how this therapeutic option could ‘potentially be the future’.  

This programme has been supported by an unrestricted educational grant from Takeda.

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