Cancer Conference Update: A Multimedia Review of Key Presentations from the 2016 American Society of Hematology Annual MeetingAbstract 1145: A multicenter, Phase I/II study of carfilzomib, pomalidomide and dexamethasone in patients with RRMM
2:33 minutes.
TRANSCRIPTION:
DR MIKHAEL: So carfilzomib is a very potent proteasome inhibitor. Pomalidomide right now is our most potent immune modulatory drug. And so in clinical practice here, we have been combining them on a regular basis. There have been some Phase I studies presented. This was now bringing us to a Phase II study, a European group looking at this. And again, it was very encouraging to see that these are 2 drugs without a lot of overlapping toxicity that are very effective together. In fact, prior to the entrance of daratumumab, this was quite likely the most potent combination of 2 drugs that we have. Sadly, if patients progressed on car/pom/dex, very often their prognosis was awful. Now, we can rescue many of these now with daratumumab and others. But I think it just speaks to the potency of those 2 drugs. And this abstract just further enhanced the usefulness of that combination. It was not surprising to us, as we’ve combined them before. But to see these two in this context is something that we’re going to see a lot more of — in fact, what we often recommend in patients who have relapsed on prior combinations of both an immune modulatory drug and a proteasome inhibitor together. DR LOVE: And I was going to ask you how you decide, because certainly car/pom/dex is a very common regimen utilized. How do you decide between that and daratumumab with something? DR MIKHAEL: Yes. That’s the million-dollar question, Neil, is, what do you do when you have these combinations available to you? And I’m not sure we know the perfect sequence. What I try and tell my patients is that we’ve got great drugs like carfilzomib/pomalidomide and daratumumab. And we will almost definitely use all 3 at some point. Right now we don’t have very strong evidence to combine all 3 together, although I just say anecdotally, I’ve had a few patients in whom I’ve used the 3 together who have just very aggressive myeloma. But as always, we look at the risk factors of the patients. We look at their convenience. We look at what they’ve tolerated before and what they’ve responded to before to try and leverage the best combination, whether it’s monoclonal antibody plus an IMiD. Like, often we’ll use dara/pom or car/pom or, indeed, using the IMiD and the proteasome together. So I don’t think there’s a wrong answer. I think you go with what combination makes the most sense. And if a patient responds well, then we continue them on it. If they don’t have optimal response or relapse, obviously, we turn to the other. |