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Final Thoughts on Modern Treatment of Myeloma

Panelists:Keith Stewart, MD, CHB, Mayo Clinic;William I. Bensinger, MD, Swedish Cancer Institute;Rafael Fonseca, MD, Mayo Clinic;C. Ola Landgren, MD, PhD, Memorial Sloan Kettering Cancer Center;Jatin P. Shah, MD, MD Anderson Cancer Center
Published Online: Friday, Sep 16, 2016



Transcript:

Keith Stewart, MD, CHB:
Thank you, everybody. I think this has been extremely informative. We’ve discussed several important scenarios in the treatment and management of multiple myeloma. Before we end this discussion, I’d like to get final thoughts from each of our panelists. So, Dr. Bensinger, some final thoughts.

William I. Bensinger, MD: Well, I think now that we have several new classes of drugs for the treatment of multiple myeloma, we can really do some important studies to design three- and possibly four-drug regimens to induce quick and high complete response rates, perhaps to MRD negativity. I think the future studies are going to be driven by MRD negativity as a surrogate endpoint for the treatment of patients and they’re going to inform us about whether or not patients need additional therapies. So, I think this is changing over time and we’re in a very good position now with this disease. I predict that we’re going to start to see an increase in the fraction of patients that are long-term survivors who are disease free in the next few years.

Keith Stewart, MD, CHB: Jatin?

Jatin P. Shah, MD: I’m just going to highlight a couple of messages. Number one is that regardless of all these therapies, use your best therapies upfront. I think we have to stick with that principle. Number two, when you look at all these new therapies, it’s no longer important just to look at the median PFS, which is one timepoint, one overall response rate. I think it’s important to start looking at things like the hazard ratio. If you look at the shape of the Kaplan-Meier curves, when did the curves separate early versus late? Do they remain separated? What’s the long-term survival? As we evaluate this as oncologists, it’s no longer just about median PFS and response rate. I think there are a lot more that we have to look at—hazard ratio, the shape of the Kaplan-Meier curves, long-term survival. I think that’s important, as well.

Keith Stewart, MD, CHB: Thank you. Rafael, closing thoughts, messages for the oncologists out there?

Rafael Fonseca, MD: Very, very quick. By the time you’re seeing this and we’re not in periscope, things will have changed just with what’s being presented at this meeting, and that’s really the current status. There’s great optimism for new treatments and new drugs, so I’m very, very pleased by that. I agree with everything that has been said before. With myeloma, we’re learning more and more that the important things go hand-in-hand; progression-free survival, overall survival, quality of life. All those things seem to go hand in hand. There’s exceptions to that. So, as we see treatments that give us great responses, they’re giving us great PFS and overall survival. And I just, again, would like to encourage people that are seeing us from the community, we’re happy to work with you. We realize myeloma is only but a small fraction of your practice, and it’s gotten incredibly complex and we’re happy to partner as we care for these patients.

Keith Stewart, MD, CHB: Ola?

C. Ola Landgren, MD, PhD: I echo everything that the other attendees have said. I think where we are, right now, we can deliver deep, quick, and sustained freedom from disease, which is fantastic for patients. I think the three key things we have talked about that are important are MRD, three drugs, also, when we can have the disease under such good control, we can focus more on quality of life. I think that’s where the field is going—three drugs, MRD testing, and quality of life. The future is really, really fantastic for patients. And, I also agree with what Rafael just said. We are working together; we are one big family here. We have some different perspectives on things, but we still have like the big picture the same way, and we are working together with community practice. So, we are all here trying to do the same thing.

Keith Stewart, MD, CHB: Well, there you have it. It’s treat some patients earlier, use all your best drugs at first, keep them going for longer, and aim for MRD I think would be the summary of our last 90 minutes of conversation. So, thanks to all of you for your contributions to this discussion. On behalf of our panel, we thank you for joining us, and we hope you found this Peer Exchange discussion to be useful and informative.

Transcript Edited for Clarity

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Transcript:

Keith Stewart, MD, CHB:
Thank you, everybody. I think this has been extremely informative. We’ve discussed several important scenarios in the treatment and management of multiple myeloma. Before we end this discussion, I’d like to get final thoughts from each of our panelists. So, Dr. Bensinger, some final thoughts.

William I. Bensinger, MD: Well, I think now that we have several new classes of drugs for the treatment of multiple myeloma, we can really do some important studies to design three- and possibly four-drug regimens to induce quick and high complete response rates, perhaps to MRD negativity. I think the future studies are going to be driven by MRD negativity as a surrogate endpoint for the treatment of patients and they’re going to inform us about whether or not patients need additional therapies. So, I think this is changing over time and we’re in a very good position now with this disease. I predict that we’re going to start to see an increase in the fraction of patients that are long-term survivors who are disease free in the next few years.

Keith Stewart, MD, CHB: Jatin?

Jatin P. Shah, MD: I’m just going to highlight a couple of messages. Number one is that regardless of all these therapies, use your best therapies upfront. I think we have to stick with that principle. Number two, when you look at all these new therapies, it’s no longer important just to look at the median PFS, which is one timepoint, one overall response rate. I think it’s important to start looking at things like the hazard ratio. If you look at the shape of the Kaplan-Meier curves, when did the curves separate early versus late? Do they remain separated? What’s the long-term survival? As we evaluate this as oncologists, it’s no longer just about median PFS and response rate. I think there are a lot more that we have to look at—hazard ratio, the shape of the Kaplan-Meier curves, long-term survival. I think that’s important, as well.

Keith Stewart, MD, CHB: Thank you. Rafael, closing thoughts, messages for the oncologists out there?

Rafael Fonseca, MD: Very, very quick. By the time you’re seeing this and we’re not in periscope, things will have changed just with what’s being presented at this meeting, and that’s really the current status. There’s great optimism for new treatments and new drugs, so I’m very, very pleased by that. I agree with everything that has been said before. With myeloma, we’re learning more and more that the important things go hand-in-hand; progression-free survival, overall survival, quality of life. All those things seem to go hand in hand. There’s exceptions to that. So, as we see treatments that give us great responses, they’re giving us great PFS and overall survival. And I just, again, would like to encourage people that are seeing us from the community, we’re happy to work with you. We realize myeloma is only but a small fraction of your practice, and it’s gotten incredibly complex and we’re happy to partner as we care for these patients.

Keith Stewart, MD, CHB: Ola?

C. Ola Landgren, MD, PhD: I echo everything that the other attendees have said. I think where we are, right now, we can deliver deep, quick, and sustained freedom from disease, which is fantastic for patients. I think the three key things we have talked about that are important are MRD, three drugs, also, when we can have the disease under such good control, we can focus more on quality of life. I think that’s where the field is going—three drugs, MRD testing, and quality of life. The future is really, really fantastic for patients. And, I also agree with what Rafael just said. We are working together; we are one big family here. We have some different perspectives on things, but we still have like the big picture the same way, and we are working together with community practice. So, we are all here trying to do the same thing.

Keith Stewart, MD, CHB: Well, there you have it. It’s treat some patients earlier, use all your best drugs at first, keep them going for longer, and aim for MRD I think would be the summary of our last 90 minutes of conversation. So, thanks to all of you for your contributions to this discussion. On behalf of our panel, we thank you for joining us, and we hope you found this Peer Exchange discussion to be useful and informative.

Transcript Edited for Clarity
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