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Physicians’ Education Resource®, LLC, is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

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This activity is supported by an educational grant from Merck Sharp & Dohme Corp.


Cancer Summaries and Commentaries™: Update From San Diego - Advances in the Treatment of Multiple Myeloma PER Pulse™ Recap

PER Pulse Recap

PER Pulse™ Recap



1 of 3
PER Pulse Recap

Cancer Summaries and Commentaries™: Update From San Diego - Advances in the Treatment of Multiple Myeloma is an online CME activity designed to update physicians on key clinical data on multiple myeloma that were presented at the 2016 American Society of Hematology Annual Meeting. The activity features audio commentary from C. Ola Landgren, MD, PhD, and Sagar Lonial, MD, FACP, who provide their perspectives on the data and, when appropriate, how clinicians can integrate these findings into practice to improve patient care.

This first of 3 PER Pulse™ Recaps summarizing the program focuses on discussing primary results from the randomized phase III StaMINA trial, which examined the influence of different consolidation strategies following transplant on patient outcomes, including progression-free survival. In the primary results of this study of transplant-eligible patients with symptomatic multiple myeloma (N = 758), treatment regimens that involved the addition of bortezomib, lenalidomide, and dexamethasone (RVD) consolidation or an additional autologous transplant were not superior to those that involved a solitary transplant with lenalidomide maintenance in the upfront treatment of multiple myeloma. The majority of patients received RVD induction therapy. During their interviews about this abstract, Drs. Landgren and Lonial offer the following commentary points:

  • The results of this study do not support the role of a second autologous transplant for patients with multiple myeloma.
  • Dr. Landgren remarked that clinicians should consider the implications of different induction regimens on treatment outcomes, providing access to the best induction treatment regimens possible. A 3-drug combination should be considered unless any contraindications exist.
  • Dr. Lonial stated that patients should be offered the possibility of transplant/stem cell collection at an early point in treatment, if they are suitable candidates. Transplant continues to have a role in treatment for many patients with multiple myeloma.
  • Dr. Landgren emphasized the importance of monitoring for adequacy and duration of response.
  • Dr. Lonial discussed follow-up assessment of the StaMINA trial, stating that long-term follow-up data and subgroup analyses will be important, particularly to assess the role of tandem transplantation in the high-risk patient population. Data pertaining to minimal residual disease will also be important. The goal of therapy should be to maximize depth of response.


2 of 3
PER Pulse™ Recap

Cancer Summaries and Commentaries™: Update From San Diego - Advances in the Treatment of Multiple Myeloma is an online CME activity designed to update physicians on key clinical data on multiple myeloma that were presented at the 2016 American Society of Hematology Annual Meeting. The activity features audio commentary from C. Ola Landgren, MD, PhD, and Sagar Lonial, MD, FACP, who provide their perspectives on the data and, when appropriate, how clinicians can integrate these findings into practice to improve patient care.

This second of 3 PER Pulse™ Recaps summarizing the program focuses discussing efficacy and safety data from a phase II study of pembrolizumab, pomalidomide, and dexamethasone for relapsed/refractory multiple myeloma. The study observed similar autoimmune phenomena that were observed in prior studies with PD-1 inhibitor therapy. With respect to efficacy, the study results demonstrated a median duration of response of 8.8 months for those who responded to treatment, with a value of 10.7 months for patients who had very good partial response or better. Fifty-six percent of patients had a better than or equal to partial response. During their interviews about this abstract, Drs. Landgren and Lonial offer the following commentary points:

  • Dr. Lonial placed the study results in context, commenting that pembrolizumab alone does not have any activity in myeloma, pomalidomide has a response rate of approximately 30%, and one of the goals of the study was to assess the efficacy of the combination of these agents.
  • Dr. Lonial reported that this combination had a high response rate and a long duration of response, suggesting immunologic activation for the combination.
  • Dr. Landgren remarked on the success in the field of myeloma treatment over the past 2 years with different combinations. Many of these combinations have led to new or updated FDA approvals.
  • Dr. Landgren commented on the efficacy of the studied combination of an anti-PD1 antibody, an immunomodulatory drug (IMiD), and a steroid, which almost doubled the response rate seen with an IMiD and dexamethasone alone.
  • Dr. Lonial noted the autoimmune issues seen with the use of a PD1 inhibitor, including transaminitis, hypothyroidism, adrenal insufficiency, and interstitial pneumonitis. He stated that the frequency of these events was relatively low and not out of proportion with other diseases treated with PD1 inhibitors.
  • Drs. Landgren and Lonial stated that they anticipate that PD1 inhibitor therapy will become an important part of treatment approaches in the near future.


3 of 3
PER Pulse™ Recap

Cancer Summaries and Commentaries™: Update From San Diego - Advances in the Treatment of Multiple Myeloma is an online CME activity designed to update physicians on key clinical data on multiple myeloma presented at the 2016 American Society of Hematology Annual Meeting. The activity features audio commentary from C. Ola Landgren, MD, PhD, and Sagar Lonial, MD, FACP, who provide their perspectives on the data and, when appropriate, how clinicians can integrate these findings into practice to improve patient care.

This third of 3 PER Pulse™ Recaps summarizing the program focuses on discussing final results from a phase I trial of selinexor, carfilzomib, and dexamethasone for relapsed/refractory multiple myeloma (RRMM). Many patients with multiple myeloma are refractory to current treatment options, including proteasome inhibitors. New treatment options are being explored, including selinexor, which is a selective inhibitor of nuclear export compound. From preclinical studies, combining selinexor with a proteasome inhibitor may help to improve the safety and efficacy of treatment approaches for patients with RRMM. This phase I study sought to assess the maximum tolerated dose of the combination of selinexor, carfilzomib, and dexamethasone and establish preliminary efficacy data for this combination. A large number of the patients in this study were high-risk, with many refractory to at least 2 agents. This study yielded promising results regarding the combination, with a partial response rate of 64% or better for patients progressing on carfilzomib. During their interviews about this abstract, Drs. Landgren and Lonial offer the following commentary points:

  • Dr. Landgren commented on the strength of the response rate in this study, which supports further development of selinexor. Gastrointestinal (GI) disorders, thrombocytopenia, and fatigue were common overall adverse events (AEs), with 67% of patients experiencing grade 3/4 thrombocytopenia. Two serious AEs were reported, including an upper respiratory infection and a case of lower GI bleeding.
  • Dr. Lonial was encouraged by the data in the ongoing quest to overcome resistance to carfilzomib. He stated that the degree of grade 3/4 GI toxicity was lower than that seen with selinexor alone.





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