Multiple Myeloma | Parameswaran Hari, MD

Multiple Myeloma | Parameswaran Hari, MD


(upbeat music) – So Dr. Hari, welcome and thanks for coming and presenting at our 7th Annual Ash Review this year. And of course, you’re really
a internationally known expert in the field of multiple myeloma. And boy, that’s a field
where there have been so many changes over
the last several years. So looking back at the meeting, what do you think the over this last year the major advances in our field were? – Thanks, first of all,
for inviting me, Jeff. This is a beautiful venue and
your city is so beautiful. Coming to myeloma, we’ve had a lot of development in new drugs and the outlook for myeloma patients is improving day by day. I’ve always maintained that
to actually cure myeloma, you need multiple
different classes of agents that work together in synergy. And finally we may be coming to that. That’s probably the big
message for patients. We have a whole plethora of agents directed at a new target called BCMA, and we don’t know which
one of these approaches to attacking BCMA is gonna be
successful in the long run, but we have everything going
from CAR T-cells to antibodies to BiTE and many other
technologies like that. And with some of the old technologies, which are getting refined
with time goes by, such as transplant, double transplant, still continue to
maintain their superiority over conventional techniques and that was some of the
other findings at the meeting. – So seems to me that there was a lot of discussion around some of the very important developments
in immune therapy such as CAR T-cell therapy, but how about the initial therapy of patients with multiple myeloma. Have we learned anything there? Any different approaches? – So the initial therapy of myeloma, at least in the U.S. now is almost standardized with three drugs, and which three drugs is at
a little bit of a debate, but everyone uses a proteosome
inhibitor such as bortezomib or an IMiD such as
Revlimid and then steroids. And you can tweak it a little bit, but the question now is
can we add new agents, such as monoclonal antibodies? Can we substitute with
second generation IMiDs, second generation proteosome
inhibitors, et cetera. A bunch of studies that haven’t actually read out in four at this point, and I think that’s gonna
be the big news for the ASH coming this year in 2018. But at this time, it’s difficult to say definitive answer about the initial therapy. But on the other hand, we
now have concrete proof that if for people who
are transplant eligible, an autologous transplantation still holds a significant benefit and there’s some data from Europe suggesting that a double transplant, a tandem transplant, as we
used to do say 10 15 years ago, is still the way to go. Surprisingly, that data was not replicated in our U.S. study, and there is some differences
between the studies. But still, it is surprising
that even with the new agents, transplant seems to help augment
the responses to new agents and give people even longer remissions. The median first remission
is now more than four years, almost five years now. – And the British presented data, again confirming the importance of maintenance therapy following transplants. – Right, absolutely. There is quite a bit of data
on maintenance treatment. We have now, at least three big studies, the U.S. study, the French
study, and the British study, which is a big umbrella study with maintenance or no maintenance. And I think it is difficult to do a no maintenance study anymore because it will be unethical
to deny people maintenance. Although there are some
questions as to how long, and are there better maintenance drugs? So those kind of studies
will be done in the future. – It seems like not a
day goes by in my clinic, I’m sure it’s the same for yours, where a patient doesn’t ask you about this thing called CAR T-cell therapy. What is that and what did we
learn from the ASH meeting about the status of CAR
T-cell therapy in myeloma? – So CAR T-cells are the rage right now. And everyone wants CAR T-cells, but you know, again, the data is in phase one
studies at this point. The phase two studies are
just starting right now. They are a form of immunotherapy, perhaps a better form of immunotherapy than what we’ve ever had in myeloma. It involves taking a
patient’s own T-cells, which are immune cells, which are in effective
when a person has myeloma. It means that their T-cells are not working against the myeloma. So by definition, somebody
with active myeloma has failing T-cells. So you could take out these T-cells and genetically re-engineer them to go and fight a target that is expressed on almost all myeloma cells. And some of the results have
been surprisingly wonderful. And again, it depends to an extent on whether the patient has had multiple lines of treatment, prior. So we really don’t know at this point, beyond that they are
effective in myeloma patients, how long the effectiveness will last, whether they need to be
combined with other agents, whether they need to be combined with transplant, for example, or whether they are good
as a later stage treatment, or are they gonna be even
better in early stage treatment. All these questions
are gonna get answered. And many people hope that
they hold out promise for deep minimal residual
disease negative remissions that may go into a cure. – Well, super. Again, it’s great to have you
present to our Colorado docs and community and thanks
so much for coming. – Thank you again.
– Okay. (upbeat music)