roman hájek on behalf of cmg march 27, 2010 roman hájek on behalf of cmg march 27, 2010...
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Roman Hájek on behalf of CMG Roman Hájek on behalf of CMG March 27, 2010 March 27, 2010
Roman Hájek on behalf of CMG Roman Hájek on behalf of CMG March 27, 2010 March 27, 2010
„Treatment standards, in Czech Republic”.
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ČESKÁ MYELOMOVÁ SKUPINA
Initial Treatment StrategyInitial Treatment Strategy
Induction:• VAD or VDD•Thal + Dex• MP or MPT
High dose chemotherapy
Interferon / corticoidsThalidomide or Thal + Dexamethasone
Induction Consolidation Maintenance
Lenalidomide + DexBortezomib + DexPAD…others
Novel consolidation
Lenalidomide + DEXBortezomib combo’s, others
orNo Maintenance
Basic Treatment StrategyBasic Basic Treatment StrategyTreatment Strategy
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FOCUS ON LONG PERIOD OF LIFE WITH CANCER FOCUS ON LONG PERIOD OF LIFE WITH CANCER
10 YEARS10 YEARS
4 RELAPSES4 RELAPSES
FOCUS ON LONG PERIOD OF LIFE WITH CANCER FOCUS ON LONG PERIOD OF LIFE WITH CANCER
10 YEARS10 YEARS
4 RELAPSES4 RELAPSES
Basic Treatment StrategyBasic Treatment Strategy
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Rulesfor the treatment of MM
according guidelinesof
Czech Myeloma Group
RulesRulesforfor thethe ttreatmentreatment ofof MMMM
accordingaccording guidelinesguidelinesofof
CzechCzech MyelomaMyeloma GroupGroup
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If we have more than one treatment options than we If we have more than one treatment options than we has change treatment when it is: has change treatment when it is:
A: NOT EFFECTIVE A: NOT EFFECTIVE
B: POORLY TOLERATED B: POORLY TOLERATED
/neropathy//neropathy/
If we have more than one treatment options than we If we have more than one treatment options than we has change treatment when it is: has change treatment when it is:
A: NOT EFFECTIVE A: NOT EFFECTIVE
B: POORLY TOLERATED B: POORLY TOLERATED
/neropathy//neropathy/
Reason for the Treatment DiscontinuationReason for the Treatment Discontinuation
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STABLE DISEASE STABLE DISEASE IS NOT SUTISFIED RESPONSEIS NOT SUTISFIED RESPONSE
MINIMAL RESPONSE (M-Ig MINIMAL RESPONSE (M-Ig < 50< 50%) %) IS NOT SUTISFIED RESPONSEIS NOT SUTISFIED RESPONSE
STABLE DISEASE STABLE DISEASE IS NOT SUTISFIED RESPONSEIS NOT SUTISFIED RESPONSE
MINIMAL RESPONSE (M-Ig MINIMAL RESPONSE (M-Ig < 50< 50%) %) IS NOT SUTISFIED RESPONSEIS NOT SUTISFIED RESPONSE
Reason for the Treatment DiscontinuationReason for the Treatment Discontinuation
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STABLE DISEASE STABLE DISEASE IS NOT SUTISFIED RESPONSEIS NOT SUTISFIED RESPONSE
MINIMAL RESPONSE (M-Ig MINIMAL RESPONSE (M-Ig < 50< 50%) %) IS NOT SUTISFIED RESPONSEIS NOT SUTISFIED RESPONSE
STABLE DISEASE STABLE DISEASE IS NOT SUTISFIED RESPONSEIS NOT SUTISFIED RESPONSE
MINIMAL RESPONSE (M-Ig MINIMAL RESPONSE (M-Ig < 50< 50%) %) IS NOT SUTISFIED RESPONSEIS NOT SUTISFIED RESPONSE
Reason for the Treatment DiscontinuationReason for the Treatment Discontinuation
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WE NEED AT LEAST PARTIAL RESPONSE
New drugs have significant benefit for patients New drugs have significant benefit for patients with relapse and resistant diseasewith relapse and resistant disease
The key rules are: The key rules are:
1. Do not use monotherapy1. Do not use monotherapy
2. Reserve other new drugs for the 2. Reserve other new drugs for the futurefuture
Benefit of the new drugs - Benefit of the new drugs - thalidomide and bortezomibe, lenalidomidethalidomide and bortezomibe, lenalidomide
Benefit of the new drugs - Benefit of the new drugs - thalidomide and bortezomibe, lenalidomidethalidomide and bortezomibe, lenalidomide
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Treatment Strategyfor
JUNIORS (< 65 years)
TreatmentTreatment StrategyStrategyforfor
JUNIORS JUNIORS ((< 65 years< 65 years))
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1. NEW DIAGNOSIS: THALIDOMID + TRANSPLANTATION (gold standard)
1. NEW DIAGNOSIS: THALIDOMID + TRANSPLANTATION (gold standard)
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2. FIRST RELAPSE
NEUROPATHY: NO VELCADE based regimen
NEUROPATHY: YES REVLIMIDE based regimen
+ re-transplantation if the regimen is toxic or response after 4 cycle is less than 50% (PR)
2. FIRST RELAPSE
NEUROPATHY: NO VELCADE based regimen
NEUROPATHY: YES REVLIMIDE based regimen
+ re-transplantation if the regimen is toxic or response after 4 cycle is less than 50% (PR)
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33. THIRD RELAPSE: THALIDOMID VELCADE REVLIMID based regimen
+ re-transplantation if the regimen is toxic or response after 4 cycle is less than 50% (PR)
33. THIRD RELAPSE: THALIDOMID VELCADE REVLIMID based regimen
+ re-transplantation if the regimen is toxic or response after 4 cycle is less than 50% (PR)
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Treatment Strategyfor
SENIORS (> 65 years)
TreatmentTreatment StrategyStrategyforfor
SENIORS SENIORS ((> 65 years> 65 years) )
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1. NEW DIAGNOSIS: 80% THALIDOMID 20% VELCADE based regimen 1-3. FIRST RELAPSE: THALIDOMID VELCADE REVLIMIDE based regimen
1. NEW DIAGNOSIS: 80% THALIDOMID 20% VELCADE based regimen 1-3. FIRST RELAPSE: THALIDOMID VELCADE REVLIMIDE based regimen
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CTD junior and senior
JUNIOR SENIOR Cyclophosphamide 500mg p.o. day 1, 8, 15 50mg daily Thalidomid 200 mg 100 mg Dexamethazon
40 mg day 1-4, 10-13, 20-23 20 mg
CTD junior and senior
JUNIOR SENIOR Cyclophosphamide 500mg p.o. day 1, 8, 15 50mg daily Thalidomid 200 mg 100 mg Dexamethazon
40 mg day 1-4, 10-13, 20-23 20 mg
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VELCADE based regimens CVD junior and senior VMP junior and senior VD junior and senior
THALIDOMIDE based regimens CTD junior and senior
MPT junior and senior TD junior and senior (Cyclophosphamide or melphalan; corticoids; new drug)
VELCADE based regimens CVD junior and senior VMP junior and senior VD junior and senior
THALIDOMIDE based regimens CTD junior and senior
MPT junior and senior TD junior and senior (Cyclophosphamide or melphalan; corticoids; new drug)
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Effective drugs usedin Czech Rep.
in numbers
EffectiveEffective drugsdrugs usedusedin in CzechCzech RepRep..
in in numbersnumbers
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NADAČNÍ FONDCMGCMGC
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ČESKÁ MYELOMOVÁ SKUPINAČeská myelomová skupina a její nadační fond spolupracují při zajišťování informačního servisu pro lékaře a nemocné s mnohočetným myelomem
DRUG/No. of Pts. 2008 2009 2010 MYRIN
(thalidomid) 453 600 560 VELCADE
(bortezomib) 187 380 480 REVLIMID (lenalidomid) 20 120 160
Celkem 660 1100 1200 Total 660 1100 1200
(Total of 1200 from 1600 pts. indicated for the treatment in the year 2010 received effective treatment
Treatment of Multiple Myeloma in Czech Republic Effective drugs used in the period 2007-2009.
How can we improve results&
How patient organisation canhelp ?
HowHow cancan wewe improveimprove resultsresults&&
HHowow patientpatient organisationorganisation cancanhelp ?help ?
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HOW TO INTRODUCE THE
BENEFIT OF treatment TO ALL
SUITABLE PATIENTS
How can patient organization help?How can patient organization help?
KEY FOR EVERYDAY ROUTINE:
EFECTIVE AND SHORT TRANSMISSION OF CLINICAL TRIALS RESULTS INTO EVERYDAY USE WITH POSITIVE BENEFIT FOR THE PATIENTS..
KEY FOR EVERYDAY ROUTINE:
EFECTIVE AND SHORT TRANSMISSION OF CLINICAL TRIALS RESULTS INTO EVERYDAY USE WITH POSITIVE BENEFIT FOR THE PATIENTS..
ACCURATE AND MAXIMAL ENROLMENT ACCURATE AND MAXIMAL ENROLMENT TO TRANSPLANTATION PROGRAMTO TRANSPLANTATION PROGRAM
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ConlusionsConlusionsConlusions
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Autologous transplantationis
gold standardfor newly diagnosed patients with MM at age under 65
Autologous transplantationAutologous transplantationisis
goldgold standard standardfor for newly diagnosed patientsnewly diagnosed patients with with MM MM at ageat age underunder 65 65
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To use thalidomide or VelcadeTo use thalidomide or Velcade based regiment based regiment as first line treatmentas first line treatment in all elderly patients in all elderly patients up front up front
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Our strategy for routine life in period 2007-2010 Our strategy for routine life in period 2007-2010
Our strategy for routine life in period 2007-2010 Our strategy for routine life in period 2007-2010
To use To use VELCADE/THALIDOMIDE/REVLIMIDEVELCADE/THALIDOMIDE/REVLIMIDE based regiment based regiment as 2 – 4 lines treatmentas 2 – 4 lines treatment in all patients in all patients
Our strategy for routine life in period 2006-2010 Our strategy for routine life in period 2006-2010
Our strategy for routine life in period 2006-2010 Our strategy for routine life in period 2006-2010
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There is evidence that new drugs There is evidence that new drugs can can significantly change prognosis of significantly change prognosis of more more than 50% of patients who can t than 50% of patients who can t benefit benefit from autologous transplantation from autologous transplantation as as primary treatment primary treatment
Where we are going ? Where we are going ?
Where we are going ? Where we are going ?
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Long-term treatment results Long-term treatment results Long-term treatment results Long-term treatment results
Period
Med
ián
Overa
ll S
uri
vval (m
on
ths)
10
60
70
20
30
40
50
1971–1976 1977–1982 1983–1988 1989–1994 1995–2000 2000–2006
0
n = 2981
Kumar, et al., 2008, Blood 111(5): 2516
We need use new drugs in elderly We need use new drugs in elderly patients patients to achive the similar results as in to achive the similar results as in younger younger patients using autologous patients using autologous transplantationtransplantation
We need less toxic and more safe We need less toxic and more safe induction treatment than VAD for induction treatment than VAD for younger patientsyounger patients
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Our strategy for routine life in period 2006-2010 Our strategy for routine life in period 2006-2010 SUMMARY SUMMARY
Our strategy for routine life in period 2006-2010 Our strategy for routine life in period 2006-2010 SUMMARY SUMMARY
How can patient organizations help? How can patient organizations help?
It is very important, if any of evalauted therapies It is very important, if any of evalauted therapies is considered as new perspective treatment. is considered as new perspective treatment.
The more important is, if the most patients can The more important is, if the most patients can benefit from this treatment in the short time period.benefit from this treatment in the short time period.
Rapid introduction of new effective therapeutic Rapid introduction of new effective therapeutic strategy strategy is the place for active patient organizations. is the place for active patient organizations.
It is very important, if any of evalauted therapies It is very important, if any of evalauted therapies is considered as new perspective treatment. is considered as new perspective treatment.
The more important is, if the most patients can The more important is, if the most patients can benefit from this treatment in the short time period.benefit from this treatment in the short time period.
Rapid introduction of new effective therapeutic Rapid introduction of new effective therapeutic strategy strategy is the place for active patient organizations. is the place for active patient organizations.
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Thank you for you attention Thank you for you attention Thank you for you attention Thank you for you attention
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