This morning’s myeloma session was three hours long. Three! It was a three-hour tour, a three-hour tour:
I'm Gilligan. Everyone else was the professor.
I made it through a little over two and a half hours of the session. It started at 9:30, and by about 10:30 I started to get the munchies, and I spent the next hour and a half trying to focus on all of the graphs and charts and data instead of on the free M&Ms I’d picked up from the Managing Myeloma booth that were still in my bag. None of the hundreds of black-suit-wearing scientific types all around me were digging for M&Ms in their bags, so I fought the temptation and did not give in. In my defense, the guy right in front of me fell asleep, so I figured at least I had him beat. I might have been thinking about M&Ms, but at least I was fully awake.
Finally, around noon, I was so starving I couldn't take it anymore and had to run to the concession stand. The charts and graphs were turning into giant hams, like in cartoons. I had to head out, but I learned several important things.
For one thing, Bortezomib (aka Velcade) is pronounced “bore-tez-uh-mib”, which is more than I knew when I arrived at ASCO. I’d read the word before, but I’d pronounce it in my brain like, “Bortey-blah-blah-uh-bib.” So that’s nice to know.
The first sessions this morning were about finding new ways to combine existing drugs to make them more effective. For example, when you combine "bore-tez-uh-mib" and thalidomide (somewhat newer drugs) with melphalan and prednisone (back-in-the-olden-times drugs) you get a good response. I walked in a couple minutes late on this one, but right as I walked in, the presenter said, “This is the best available treatment option for the elderly patient.”
The next study combined low-dose "bore-tez-uh-mib" (Velcade) with reduced-dose thalidomide and dex, and compared it to regular-dose Velcade plus dex as induction therapy prior to a stem-cell transplant. It was a VTD vs. VD smackdown!! Who emerged victorious? Velcade, Thal, and Dex kicked Velcade/Dex’s butt! Woo hoo! I also jotted something down in my notes that said, “Toxic death = 0.” That’s always good to know. Also, Toxic Death would be an excellent name for a band.
The next presentation was pretty interesting, in that it found a drug combo (melphalan, prednisone, and Revlimid) that seems to get the same results as a transplant, without the horrible side effects of a transplant. I wrote down, “works the same, and safety profile is one of the best.” It was stressed that more follow-up is needed, but it’s still pretty exciting.
Next, another drug combo was presented: Revlimid, Velcade, and Dex in patients with newly diagnosed myeloma. I jotted down, “This is the first regimen to get 100 percent response rate without a transplant”, and “May represent basis of future standard of care.”
Then there was a brief discussion on the role of transplant in myeloma:
(I thought your eyes and brain could use a break for a minute)
The presenter asked, “Is it really time to abandon the transplant? Maybe … but not yet.” More follow-up is needed on all of these studies, but, heck, I think a “maybe” is much better news than, “Hell, no!” Am I right? I also wrote down, “Up-front transplant might be useful only in subgroups of patients”, meaning that the rest of us can get away without one.
Finally, just before I succumbed to starvation, there were two presentations on the use of Revlimid as maintenance therapy after a transplant. This means, you have a transplant, and then you take low-dose Rev, maybe forever. Both studies agreed that the Rev greatly improved progression-free survival, but, again, more follow-up is needed to see how it affects overall survival. One study did find that 88 percent of patients on this regimen were still alive four years after diagnosis, which seems huge to me, since the five-year survival statistic for myeloma used to be a dismal 30-something-percent.
After we grabbed some lunch, we were off to the airport, and now we're back in KC. Our whirlwind tour of Chicago is over. (I'm planning a future blog post with a few photos, so stay tuned.) I thought it was a great time, and I am so grateful to the IMF for flying us out there. I also just want to drop a tiny hint in the IMF's direction that I heard about an upcoming myeloma conference in Paris. Cough cough.
I'll try to sum up what I learned:
1) Lots and lots and lots of people go to ASCO
2) Many of the booths hand out free chocolate, jellybeans, and cappuccino
3) If you're a newly diagnosed myeloma patient, have faith: There are lots of new drug combos and new drugs on the horizon, and you're sure to find many, many options to fight off your disease for a long time to come.
4) Even if you're an old-timer myeloma patient and other therapies have failed you, one of the newer ones might work for you.
5) The Celgene booth was also handing out free chocolate-covered biscotti.