1. Future Strategies for Myeloma
Dr Patrick Hayden
St. James’s Hospital
Multiple Myeloma Ireland
Patient and Family Information Day
10th November 2016

2. Talk Where are we now? Advances in Diagnosis Advances in Treatment
Advances in Supportive Care
Summary

3. Talk Where are we now? Advances in Diagnosis Advances in Treatment
Advances in Supportive Care
Summary

4. Myeloma in Ireland 235 people diagnosed in Ireland each year
More people are living longer with myeloma
Increasing prevalence of a chronic disease

8. Talk Where are we now? Advances in Diagnosis Advances in Treatment
Advances in Supportive Care
Cases
Summary

10. CRAB criteria A raised Calcium level Renal (kidney) damage Anaemia
Bone disease

12. Serum Free Light Chain Assay (SFLC)

13. How to measure disease If IgG or IgA 70% of patients
Serum protein electrophoresis (SPEP)
If light chain (kappa or lambda)
Then Urine collection or
Serum Free Light chain assay (SFLC assay)

17. Talk Where are we now? Advances in Diagnosis Advances in Treatment
Advances in Supportive Care
Summary

19. 19

24. Bortezomib (Velcade)

25. Bortezomib side-effects
Peripheral neuropathy
Low platelets
Increased risk of shingles
Take anti-viral drug

27. Subcutaneous Velcade

31. Lenalidomide (Revlimid)

33. Lenalidomide side-effects
Compared to Thalidomide
Less constipation
Less neuropathy
Less sedation
Reduces blood counts
Increased risk of blood clots

36. New drugs

38. Pomalidomide

41. Carfilzomib

42. Daratumumab: Mechanism of Action
 Human CD38 IgGκ monoclonal antibody
 Direct and indirect anti-myeloma activity1-5
 Depletes CD38+ immunosuppressive regulatory cells5
 Promotes T-cell expansion and activation5
Lammerts van Bueren J, et al. Blood. 2014;124:Abstract 3474.
Jansen JMH, et al. Blood. 2012;120:Abstract 2974.
de Weers M, et al. J Immunol. 2011;186:
Overdijk MB, et al. MAbs. 2015;7:
Krejcik J, et al. Blood Epub ahead of print.

43. Phase 3 Randomized Controlled Study of Daratumumab, Bortezomib and Dexamethasone (DVd) vs Bortezomib and Dexamethasone (Vd) in Patients with Relapsed or Refractory Multiple Myeloma (RRMM): CASTOR*
Antonio Palumbo, Asher Chanan-Khan, Katja Weisel, Ajay K. Nooka, Tamas Masszi, Meral Beksac, Ivan Spicka, Vania Hungria, Markus Munder, Maria Victoria Mateos, Tomer Mark, Ming Qi, Jordan Schecter, Himal Amin, Xiang Qin, William Deraedt, Tahamtan Ahmadi, Andrew Spencer, and Pieter Sonneveld on behalf of the CASTOR investigators
Palumbo A, et al. Oral presentation at ASCO 2016 (abstract LBA4)
*NCT

45. Talk Where are we now? Advances in Diagnosis Advances in Treatment
Advances in Supportive Care
Summary

48. Almost 2000 patients followed for an average of 6 years
The overall incidence of confirmed ONJ with Zometa was 3.7%
Most occurred between 8 and 30 months
Among 10 patients with ONJ recovery data,
dental surgery or trauma preceded the ONJ in 6 patients

51. Kidney damage Renal impairment common in myeloma Hydration important
Paracetamol OK
Solpadeine (paracetamol/codeine) OK
Beware of aspirin-type pain killers
e.g. Difene, Voltarol, Brufen

52. Activity levels

53. Talk Where are we now? Advances in Diagnosis Advances in Treatment
Advances in Supportive Care
Summary

54. Summary Major advances in the treatment of myeloma in all age groups
Same drugs being used in smarter ways
Good pipeline of novel agents
Supportive care critical
Importance of exercise for physical and mental health

55. Further reading

57. Further reading www.myelomabeacon.com www.myeloma.org.uk

58. Thank You