- Elotuzumab is a laboratory-manufactured monoclonal antibody which works against a cell surface glycoprotein, CS1, highly expressed in multiple myeloma (MM). Like the antibodies that our own bodies produce, it attaches to the target protein and kills or disables the cell possessing that protein. It has been tested successfully in Phase I and II trials with both Velcade and Revlimid. In the Revlimid trial, 28 patients with lots of prior therapies experienced an overall response rate of 82%. Not bad. I personally believe that many more monoclonal antibodies are in our future - these are the "silver bullets," highly-directed therapy that really could make myeloma a chronic disease. Someday, not yet.
By the way - the suffix "mab" on the generic drug name elotuzumab means "Monoclonal AntiBody." We'll see more MABs.
- Denosumab (see - here's another) is also a monoclonal antibody, this time directed at a signal protein which promotes bone removal. Thus denosumab inhibits destruction of bones by myeloma and its treatments. This is cool stuff. Several Phase III studies were reported at ASCO, all of them showing an advantage for denosumab over Zometa. Quoting the conclusion of one study (9042), which included myeloma patients: "In this head-to-head study, patients receiving denosumab had longer time to first skeletal-related event (SRE) or hypercalcemia and time to radiation to bone compared with Zometa. A lower proportion of patients experienced an on-study SRE in the denosumab group compared with Zometa." In another study, patients taking denosumab experienced less bone pain than those taking Zometa.
- Vorinostat, brand name Zolinza, is already approved for some cancers. It is a new class of drug called histone deacetylase (HDAC) inhibitors. I don't know what means, actually, except that it works by a different mechanism than Revlimid, Velcade, melphalan, or dexamethasone, making it an excellent candidate for use WITH those drugs. So far it looks promising in early studies with both Velcade and Revlimid. Another HDAC inhibitor, panobinostat, also shows promise.
Nice salmon dinner aboard the Amtrak Empire Builder: