ASCO Headline: Maintenance Works

And so does consolidation. This may be the most important new information for myeloma patients this weekend.

ASCO is the American Society of Clinical Oncology, currently holding its annual meeting at McCormick Place in Chicago, 30,000 strong. I am here as a guest of the International Myeloma Foundation (IMF), to observe the information presented by the many speakers, and to blog about it from the perspective of an ordinary patient. Yay for the IMF! And thank you. I love this stuff. But be advised: I am not a doctor, just an engineer. You should get your medical advice and even your facts from your doctor.

The ASH (American Society of Hematology) conference a half-year ago suggested that maintenance works, and ASCO confirms it. What is it?

• Consolidation is a drug therapy given AFTER a stem cell transplant (SCT), to further reduce the tumor burden.
• Maintenance is administration of a drug (Revlimid, Velcade, ...) for a long period AFTER a good response has been achieved from an SCT or other therapy, to keep the ugly buggers down.

I attended a session titled "Expert Perspectives in Individualized Treatment of Hematologic Malignancies" (yikes - what was I doing there?). Dr David Vesole of Hackensack University spoke on "Updates on Innovative Treatment for Newly Diagnosed and Relapsed/Refractive Myeloma. More about that in another post.

Consolidation:

Dr Vesole cited two different studies, one using Revlimid and another using Velcade, both showing a significant advantage for consolidation. In the revlimid study, two months of Revlimid increased the percentage of patients showing a very good partial response (VGPR) or better from 58% to 70%. In the other study, Velcade was started at three months after the SCT, and continued for six months. After those nine months, 49% of the patients taking Velcade were still in near-CR or better, contrasted with 33% of the control group.

Maintenance:

The brand-newest papers on post-SCT maintenance have not been presented yet, but the abstracts are available. As Dr Durie of the IMF has pointed out in a press release dated yesterday, the new studies may influence doctors toward continuing therapy (maintenance) as a means of preventing or delaying relapse. The study results are quite clear: maintenance works. One study was "unblinded," in fact, because those on the Revlimid maintenance arm were doing so much better than those on placebo. I will attend these sessions, and will report on them if I learn anything beyond what is in the abstracts.

What does this mean for us?

Unfortunately, it's both sweet and sour. In many cases, we should probably NOT enjoy a drug holiday after achieving stable disease from an SCT or other means. Instead, going on maintenance, we will incur: (1) side effects of Revlimid or Velcade; (2) the cost of those drugs, and (3) the nuisance of taking the pills or getting the infusions. But we may likely enjoy a longer period before relapse and quite possibly a longer life. Life is good - I'm in favor of it.

What about those who are already on a drug holiday? Should I start now? Is it too late to start? Ask your doctor - I don't think the studies answer that question.