One thing that never seems to change with multiple myeloma is that nothing is black or white. There are more shades of gray than one can imagine. The more answers we get the more questions we have. That became quickly evident at our first major event on Friday, the IMF Symposium addressing Global Advances in Multiple Myeloma: Providing the Best Options for Treatment in 2015.
Dr. Durie opened the meeting by mentioning that we had three new drugs approved just last month: Darzalex (daratumumab), Ninlaro (ixazomib), and Empliciti (elotuzumab). When you think back to the days when Brian and Susie Novis and Dr. Durie founded IMF, the idea of even finding three new effective drugs probably seemed unfathomable.
The guest debaters for this meeting explored the following topics:
- whether new diagnostic criteria and early treatment improve survival or result in more aggressive disease at relapse
- whether risk-adapted therapy should be used for newly diagnosed patients
- whether Minimal Residual Disease (MRD) should be used to guide treatment decisions regarding maintenance therapy, and
- whether emerging systemic therapies are best in patients with newly or relapsed MM.
At times, it was just like watching an international soccer match. The debaters were Dr. Shaji Kumar from Mayo Rochester, Minnesota; Dr. Phillippe Moreau from University Hospital, Nantes, France; Drs. Bruno Paiva and Jesùs F. San Miguel from University of Navarra, Pamplona, Spain; and Dr. Antonio Palumbo from University of Turin, Turin, Italy. It was lively from the opening minutes; and were it a soccer match, there would probably have been a fair number of yellow and perhaps even a red card or two on the “field.” All the doctors held their own, with a sense of sport and humor. However, there was very few black or white answers, and lots of shades of gray!
There is too much specific data for the layman to walk away with in these presentations. One must understand that the intended audience of 1200 plus was not the MM patient or even support group leader representing the IMF. It was the room full of oncologists who treat MM on a daily basis and those working behind the scenes assisting and researching. The big takeaway for someone like me is that any one piece of that data could be a critical one—and one that I should be considering when ultimately considering a treatment regimen. When two world-leading oncological experts in the field can’t completely agree, it may just come down to that one little piece unique to the patient or what is important in their life. That is why when it comes to our medical care, we have to be involved.
If any of the above debate topics interest you, or you just want to get a sense of the many factors in this complex equation of gray, I suggest you explore this presentation. To watch this event, click HERE.