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

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

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

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

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

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

Serum Free Light Chain Assay (SFLC)

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)

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

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Bortezomib (Velcade)

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

Subcutaneous Velcade

Lenalidomide (Revlimid)

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

New drugs

Pomalidomide

Carfilzomib

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;186:1840-8. Overdijk MB, et al. MAbs. 2015;7:311-21. Krejcik J, et al. Blood. 2016. Epub ahead of print.

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) *NCT02136134

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

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

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

Activity levels

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

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

Further reading

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

Thank You