Posted: 21 Aug 2011 02:50 PM PDT
Yesterday I wrote about three anti-myeloma clinical studies involving carfilzomib, elotuzumab and panobinostat.
I referred to elotuzumab and panobinostat as promising "assisting type" drugs. Also known as secondary or "helper" novel therapy agents, elotuzumab, panobinostat, vorinostat and/or ARRY520 are all showing promise working with primary novel therapy agents like thalidomide, Revlimid and Velcade.
It is hoped that carfilzomib will someday also be used as a primary therapy agent. However, don't be surprised if carfilzomib can't quite cut-it when used alone. Instead, it is likely carfilzomib will someday be a sort of super secondary or assisting type drug. Early clinical studies are showing carfilzomib works exceptionally well when combined with Revlimid.
The distinction may be irrelevant. All five of these drugs help Revlimid and/or Velcade work better and longer, often in patients who have become resistant to Revlimid or Velcade alone.
Not only that, but there are literally dozens of other new helper/secondary/assisting chemo drugs being studied now. Statistics say three or more of these should also work well.
One of my concerns is that the FDA will stop approving more secondary drugs, using the argument that they don't work any better than the five or so new drugs I mentioned by name. Hopefully the FDA will not focus on the fact that additional new drugs don't work any better, but will recognize that they may work in patients even after they have tried the other five.
Myeloma experts anticipate using different combinations of these drugs to help extend the lives of multiple myeloma patients indefinitely. This is what they are referring to when you hear myeloma is becoming a chronic disease.
The only strong candidate among new, late stage anti-myeloma novel therapy agents is pomalidomide, an advanced form of thalidomide/Revlimid. Like I mentioned earlier, it is possible carfilzomib may join this exclusive club as well.
Doxil is another helper drug which is already being used. But it doesn't help all that much--and it is currently in short supply.
All of the drugs mentioned above work best when combined with the steroid dexamethasone. And myeloma docs are discovering that even primary therapy agents like Revlimid and Velcade work well together. The number one, most effective anti-myeloma therapy combination to date is Revlimid/Velcade/dexamethasone (RVD).
Confused? Simply type-in any of these names into the query box in the upper right hand corner of the page and click-on the spy glass icon.
You will be hearing a lot more about these and other promising therapies at this year's ASH meetings in San Diego the second week in December.
Feel good and keep smiling! Pat
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