gwendolyn

We are just checking in on you to see how you're doing. How about an update? We hope all is well with you!

HI Gwendolyn! Merry Christmas to you and your family. I visit Boston a lot. Great place. MGH ROCKS!!! Sorry to hear of your diagnosis, I hope that you're doing well and have found the magic of having a great attitude. :-)

Hi how are you doing? Just checking in on you. Let us know, thanks.
Greg

Info for you.

2013 Top Stories in Oncology: Myeloma

RubenNiesvizkyMD







PracticeUpdate: In your view, what developments that occurred in 2013 in myeloma research could have the most significant impact on clinical practice?

Dr. Niesvizky: Pomalidomide is one of the most important stories in 2013. It is the newest of all the immunomodulators developed and has been approved for use in relapsed/refractory multiple myeloma. It was great to hear at ASH that now individuals who have the worst prognosis actually benefit significantly with the use of pomalidomide.

Pomalidomide, as a single agent, was presented at ASH Dr. Dimopoulos in the follow-up of the approval study.1 However, two other studies are relevant, which have shown increased response rates and increased progression-free survival.

One study from our group2 showed that the addition of the antibiotic clarithromycin has increased the response rates to over 58%, even in the double refractory setting and high-risk myeloma. It is very gratifying that you can improve the life expectancy and the survival of these types of patients.

The other interesting study presented was a combination of carfilzomib, pomalidomide, and dexamethasone,3 which increased a third of the response rates. So, it’s a combination that’s going to be widely used.

PracticeUpdate: How would you approach a patient with relapsed or refractory multiple myeloma at this point? What does the evidence suggest is the best therapy or the best approach?

Dr. Niesvizky: That’s a very difficult question because the situation is different for each patient. In other words, you’re going to have patients in earlier relapse, who require just a new drug; whereas, you have patients who have failed everything, and pomalidomide should be your potential drug in that group. So, I cannot tell you which one is the best regimen all around; but, certainly, the combination of pomalidomide and carfilzomib seems very attractive. The only problem with that combination is that it will be very expensive because they are both novel agents. Whereas the combination of pomalidomide and clarithromycin is oral and is much cheaper, which is why we are favoring it.

PracticeUpdate: Are there any other developments in myeloma in 2013 that you feel the practicing oncologists should be aware of?

Dr. Niesvizky: Certainly, the development of new monoclonal antibodies is important. One is called elotuzumab, and the other is daratumumab; there are others coming. One by Sanofi, SAR (SAR650984) appears to be a very effective single-agent with activity against relapsed/refractory multiple myeloma. This is the first time in years that an antibody actually has shown activity.

Elotuzumab has only shown activity when combined with lenalidomide and dexamethasone; it has no activity by itself, which is intriguing—why does it have no activity as a single agent, and, yet, when it’s combined with lenalidomide and dexamethasone it has such a tremendous activity? That’s why we are eager to see the results of the randomized trial of elotuzumab.

On the other hand, there are the CD38 antibiotics, of which there are now three. One is the daratumumab, in a study run by J&J, one is run by Sanofi, and then there’s a third one by Celgene. The three of them appear to be very exciting molecules that may exhibit single-agent activity. It’s not only that now we have an antibody, but we also have single-agent activity. They are being studied in combination with immunomodulatory drugs, steroids, and with proteasome inhibitors, and they all appear to be very well-tolerated.

PracticeUpdate: Would you sum up how you view the clinical developments this year in the treatment of myeloma?

Dr. Niesvizky: I would say the development of very effective induction regimens all surpassing 90% overall response rate or reaching more than 50% complete responses. The next step will be to develop surrogate markers in terms of minimal residual disease to see which one of these combinations give the best results, and how they translate in long-term survival. We are waiting for next year to see what the role of transplant will be in all these patients as we have better drugs.

In terms of maintenance, there is a general consensus that long-term therapy is superior to limited therapy in the elderly, but that still needs to be proven in the transplant setting; whereas, there is conflicting evidence whether maintenance therapy is indeed necessary.

Finally, in the relapsed/refractory setting, the new drugs, particularly the newer proteasome inhibitors, including the orals, the new immunomodulators, and, more importantly, the monoclonal antibodies are bringing a lot of promise in myeloma.

Hope the info helps, Carm

Thank you.

Thanks for your reply.... I kind of don't want to know but then I wouldn't have time to be with my family if it's bad news. I would want them to know that I'm ok with it.....even though it would be a big fat lie !!!

Hi Gwendolyn......... I saw your post about the seat belt causing discomfort! I had the same problem so put the seatbelt under my arm, well lol guess the police can ticket you for improper usage of seat belt, so the officer let me go but told me if you go to your oncologist he will give you a paper signed by him that states the seat belt causes the discomfort and then you can legally have the seatbelt under your arm there so it wont bother you, so you may want to do that it really helps.

Hi, gwendolyn. You posted recently that you had a CT scan on June 21. I just wanted to follow up. Do you have the results yet? If so, how did it go?

Thanks Gwendolyn,that's a good idea. Usually I just watch the clock,but I'll try to take your advice.

Gwen--I think you nailed that question on God & cancer. I too, believe most people are so uncomfortable not having the answers to creation that they must believe in a God--but like you, not knowing everything doesn't bother me a bit!

BTW--I see you're getting Herceptin every 3 weeks--were you HER2+ ER- PR-? That's my routine right now, too.

Thanks. I hate to admit it but I'd forgotten about this risk.

I haven't found anyone yet I can talk to that had the axillary dissection. I had mine May 6. Total of 30 nodes removed (9 with lumpectomy and 23 with axillary dissection.) When did you have yours (axillary dissection) and are you in treatment yet? Thanks!

Thanks for your helpful answer to my question about bras to wear after lumpectomy! I appreciate all the help and encouragement.

Thank you. All I seem to do is stress and EAT. Your answers were so mind settling I really appreciate it. Honestly, I have yet to see my PCP, have seen the surgeon and oncologist once since this journey started. I just feel alone and sad all the time. Thank you.

Gwendolyn,

I'm glad you liked my list of necessary questions for menopause. I hope all the women on the site find it useful!...;)

Best,
Aliza

Morning!!... Thanks for your response. Yes I was one of them that finished treatment at the end of November. Hope you are doing well.

Hey wware, thanks for sharing about the Livestrong program at the YMCA. I was not aware of this but will definitely be signing up!!

Welcome. Thank you for registering. Here are a few tips to get you started:

1) Find other people like you. You can do this by clicking on "see more" in the "People Most Like You" box to the right.

2) Go to our Questions page to see what's been posted, ask a question or give some advice. Here is a link to our most popular questions: http://bit.ly/MfN45w

3) Complete your journey profile to share your experience. You can do this by clicking on "Add Experience" in the box next to your picture above.

4) Don't forget to upload a picture!

Thank you for being here and sharing your story. If you have any questions, please check out our FAQ or contact us.

Best,
Team WhatNext