PrincessMargaretCancerCentreMultipleMyelomaDay

IntroductionAnca Prica MD,MSc,FRCPC

May12,2017

Whoareyou?

• 1)Physician• 2)Nurse• 3)Pharmacist• 4)Trainee• 5)Other

HowmanytimeshaveyoubeentoPMMyelomaDay?

1)Thisismyfirsttime2)Secondtime3)Threeormoretimes

Whatgreatdistancedidyoutraveltocometoday?

1. IliveintheGTA2. 25-50km3. 50-100km4. 100-200km5. >200km

Objectivesofthismeeting

• Tointroduceemergingdatathatinformthechangingstandardsofcareinmyelomaandrelateddisorders

• ToprovideanupdateonPrincessMargarettreatmentguidelines/policies

RationaleforImmuno-OncologyinMultipleMyeloma

• Multiplepotentialtargetsforimmunotherapy1,2

• GenerateMoAbs againstmyelomacellsurfaceAgs

• SLAMF7• CD38

• TargetP1-PDL-1pathways• IncreasedlevelsofPD-1onpatient

myelomacells• IncreasedPD-L1onpatientTcells

• Targetotherabnormalitiesinmyeloma,suchas

• ActivationofTregs• AlterationsinNKcellfunction• CompromisedTcellimmunity

Tregprecursor Cytotoxic T-cellNKcell

CT-011Lenalidomide

PD-1

Tregs

NK82D

circulatingMICA

Bortezomib

SheddingMICA

NKG2D

γδ Tcell

BisphosphonatesIL-2

Th1

IL-6

Glycolipids

↓CD1d

NKTcell

Th17 IL-27Lyticbonelesions

IMiDs

↓IFNγ

α-GalCer

NIC-mediated ADCCMonoclonal Abs

Dexamethasone IMiDs

circulatingMICA

SLAMF7

ClassIHLA PD-L1

NIC620NKp-16

CD16↓2B4

↓DNAM-1

IMiDs

MalignantPlasmaCell

Figurefrom Dosani T,etal.BloodCancerJ.2015;5:e306.doi:10.1038/bcj.2015.32.1DosaniTetal.BloodCancerJ.2015;5:e306.doi:10.1038/bcj.2015.32;2RayA,etal.Leukemia. 2015;29:1441-1444.Courtesy of Donna Reece

MyelomaTrialswithPD-1/PD-L1Inhibitors

• Publishedstudies• Pembrolizumab—phaseI/IItrialsinRRMM

• Keynote-023- withlenalidomide+dex:ORR50%(38%inlen refractory)with3%CR;MDR11.3months

• “Pem-pom”:withpomalidomide+dex:ORR60%(55%fordoublerefractory)with4%CR;MDR8.8months

• Nivolumab• Singleagent

• Resultsgood inHodgkin’s disease• Only1/27MMptsrespondedwithCR(4%);17(63%)hadstabledisease

1San Miguel J, et al. Blood 2015 126:505; 2Badros A, et al. Blood 2016 128:490; 3 Leoskhin AM, et al. J Clin Oncol 2016; 23: 2698-2704.

Youseeanewlydiagnosed76yr oldmyelomapatient,withbonylesions,Hb of94g/L,andCrCl 37ml/min.

Whatisyourpreferredfirstlineregimen?

1. Lenalidomideanddexamethasone,doseadjustedforCrCl.2. VMP(bortezomib,melphalan,prednisone)3. CyBor-D4. CyBor-P

HowmanypatientsareyoumanaginginyourpracticewithCastleman’sdiseaseoverthepastyear?

• 1)None• 2)1• 3)2• 4)3ormore

Whatisyourgutreactiontolookingafteramyelomaptinthecurrenttreatmentclimate?

1. Intermittentpanicatthenumberoftreatmentoptions/combinations2. Excitementatthenumberoftreatmentoptions/combinations3. Chronicdreadaboutthenumberoftreatmentoptions/combinations4. Confusionaboutthenumberoftreatmentoptions/combinations

PM Multiple Myeloma Day – May 12, 2017

8:00 WelcomeandIntroductions – Dr.AncaPrica

8:15 “RelapsedMyeloma– SequencingTreatments”

– Dr.Noopur Raje(Keynotespeaker)

9:00 “HighRiskMyeloma:TheRoleofStemCellTransplant”– Dr.DonnaReece

9:40 “ManagementoftheElderlyMyelomaPatient”– Dr.PeterAnglin(Guestspeaker)

10:10 RefreshmentBreak

10:30 SmallGroupCase-BasedBreakoutSessions

12:00 Lunch

1:00 “Venous ThromboembolisminMyeloma”– Dr.ChristineChen

1:20 “MulticentricCastleman’sDisease”– Dr.VishalKukreti

1:40: “UpdateonNovelTherapiesintheMylelomaPipeline”– Dr.SuzanneTrudel

2:10 ClosingRemarksandEvaluation- Dr.AncaPrica

PM Multiple Myeloma Day – May 12, 2017

10:30am- SmallGroupCase-BasedBreakoutSessions

1.Relapsed/refractorymyeloma MainBallroomDrs.Raje&Chen

2.Amyloidosis ValleyannaDrs.Kukreti&Trudel

3.MyelomaintheElderly AcademyofMedicineDrs.Anglin&Prica

4.Stemcelltransplantinmyeloma DunveganRoomDrs.Reece&Alfar

5.Managementoftherapy-relatedtoxicities DonningvaleRoomSuzanneRowland(NP),PMMyelomaNursingStaff:EthlynFerdinand,LuisaDelRizzo,EllenChurch;andDr.Nikonova (fellow)

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