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The 24th National Conference on Clinical Oncology and the 2021 CSCO Annual Conference will be held on September 25-29, 2021.
The theme of this conference is "Focus on Innovative Research, Leading the Original Future"
.
The conference continues to adhere to the fundamental purpose of CSCO, adopts new forms to actively carry out academic exchange activities in special periods, promotes academic exchanges and scientific and technological cooperation in the field of clinical oncology in China, encourages support for clinical research and innovation, and advocates multidisciplinary standardized comprehensive treatment based on Precision oncology actively promotes the development of the discipline
.
At this CSCO conference, Professor Chen Wenming from Beijing Chaoyang Hospital affiliated to Capital Medical University gave a theme report on "Treatment Progress in Relapsed and Refractory Multiple Myeloma (RRMM)".
Yimaitong organized the main contents as follows
.
Multiple myeloma (MM) is a malignant clonal plasma cell disease, accounting for about 10% of hematological malignancies
.
There is still no cure for MM, and relapse and refractory are the main clinical problems
.
Professor Chen Wenming first introduced the treatment and management of the first relapse and multi-line relapse of MM patients
.
For patients with MM who relapse for the first time, it is necessary to determine the timing of treatment, and choose a combination regimen based on nalidomide or bortezomib; for patients with multiple relapses, immunotherapy targeting the BCMA target can bring better results for patients.
Great benefit
.
The treatment and management of the first relapse of MM patients Since the market of thalidomide in 1999, 15 new drugs have been used in the treatment of MM
.
Professor Chen Wenming said that the application of new drugs usually accompanies the problem of relapse and refractory treatment, but not all relapsed MM need immediate treatment
.
It is needed when patients with relapsed MM have clinically advanced CRAB symptoms (increased blood calcium, renal damage, anemia, bone destruction) and rapid biochemical recurrence (high risk, accompanied by kidney or nerve damage, rapid increase in M protein) Treatment
.
When MM patients receive lenalidomide maintenance treatment and relapse after induction therapy, different treatment options can be selected according to the resistance of lenalidomide
.
The phase III POLLUX study included RRMM patients who had received at least one treatment regimen and were not resistant to lenalidomide, compared the Dara-Rd regimen (daratumumab, lenalidomide, dexamethasone) and The progression-free survival (PFS) of the Rd (lenalidomide, dexamethasone) regimen in the treatment of RRMM
.
The results of the study showed that the median PFS of the Dara-Rd regimen was 44.
5 months, and the median PFS of the Rd regimen was 17.
5 months; the Dara-Rd regimen had a very good partial remission and better remission (≥VGPR) rate of 81%, The ≥VGPR rate of the Rd scheme is 49%
.
The Dara-Rd regimen can be used as a treatment option for MM patients who have relapsed for the first time and are not resistant to lenalidomide
.
The Phase III CASTOR study compared the efficacy of Dara-Vd regimen (daratumomab, bortezomib, dexamethasone) and Vd regimen (bortezomib, dexamethasone) in the treatment of RRMM
.
The results of the study showed that the median PFS of the Dara-Vd regimen was 16.
7 months, and the median PFS of the Vd regimen was 7.
1 months; the ≥VGPR rate of the Dara-Vd regimen was 63%, and the ≥VGPR rate of the Vd regimen was 29%
.
The Dara-Vd regimen can also be used as a treatment option for RRMM patients
.
For RRMM patients who are resistant to both lenalidomide and bortezomib, carfilzomib and pomalidomide-based treatment options can be selected
.
The Phase III CANDOR study compared the Dara-Kd regimen (daratumomab, carfilzomib, dexamethasone) and the Kd regimen (carfilzomib, dexamethasone) in the treatment of patients who had previously received 1-3 therapies Efficacy of RRMM patients
.
The results of the study showed that the median PFS of the Kd regimen was 15.
8 months, and the median PFS of the Dara-Kd regimen was not reached; the ≥VGPR rate of the Dara-Kd regimen was 69.
2%, and the ≥VGPR rate of the Kd regimen was 48.
7%; treatment 12th At 6 months, the proportion of patients in complete remission (CR) with minimal residual disease (MRD) negative status in the two groups was 12.
5% and 1.
3%, respectively
.
The phase III APOLLO study compared the Dara-Pd regimen (daratumumab, pomalidomide, dexamethasone) and the Pd regimen (pomalidomide, dexamethasone) for treatment with at least one therapy (including Efficacy of RRMM patients with lenalidomide and proteasome inhibitor therapy
.
The median PFS of the Dara-Pd regimen and the Pd regimen were 12.
4 months and 6.
9 months, respectively; the ≥VGPR rate of the Dara-Pd regimen was 51%, and the ≥VGPR rate of the Pd regimen was 20%
.
The phase III OPTIMISMM study evaluated the efficacy of a three-drug combination regimen based on pomalidomide in RRMM patients who had previously received nallidomide treatment
.
The results of the study showed that compared with the Vd regimen, the PVd regimen (pomalidomide, bortezomib, dexamethasone) can significantly prolong the PFS of RRMM patients (median PFS: 11.
2 months vs 7.
1 months; P<0.
001)
.
For RRMM patients who failed the first-line treatment, the PVd regimen can significantly prolong the PFS compared with the Vd regimen (median PFS: 20.
73 months vs 11.
63 months; P=0.
0027)
.
Professor Chen Wenming said that for RRMM patients who relapse after maintenance treatment with lenalidomide and are not resistant to bortezomib, the PVd regimen is also a better treatment option
.
Principles of treatment for RRMM patients with multiple relapses RRMM patients with multiple relapses are currently mainly treated with CD38 monoclonal antibody combined with proteasome inhibitors and immunomodulators
.
However, because the median overall survival (OS) of RRMM patients will shorten with the increase in the number of drug resistance, conventional cytotoxic drugs and targeted drugs are not effective for patients with multiple relapses
.
In recent years, the emergence of chimeric antigen receptor T cell (CAR-T) immunotherapy, antibody-drug conjugates, bispecific antibodies and other new drugs and therapies targeting BCMA targets has brought many relapses to RRMM patients.
New hope for treatment
.
The BCMA CAR-T therapy idecabtagene vicleucel (ide-cel) has been approved by the FDA for the treatment of adult RRMM patients who have received at least 3 treatment options
.
Some antibody-drug conjugates have also been approved for the treatment of RRMM in European and American countries.
Among them, the overall response rate (ORR) of Belantamab Mafodotin monotherapy for RRMM is about 30%, and the ORR of combined pomalidomide and dexamethasone can be Up to 88%
.
The efficacy of XPO-1 inhibitor Selinexor in RRMM is also worthy of attention
.
The results of the Phase III BOSTON study showed that compared with the Vd regimen, the Selinexor combined with the Vd regimen can significantly prolong the PFS of RRMM patients (median PFS: 13.
93 months vs 9.
46 months; P=0.
0075)
.
In addition to bortezomib, Selinexor combined with pomalidomide, carfilzomib, CD38 monoclonal antibody and other drugs can also benefit RRMM patients
.
Bispecific antibodies also have considerable therapeutic prospects in RRMM
.
Related research results show that the humanized BCMA/CD3 bispecific antibody Teclistamab has an ORR of 65% for RRMM, a ≥VGPR rate of 58%, and a ≥CR rate of 40%
.
Summary Professor Chen Wenming concluded that: MM patients should avoid over-treatment, especially for patients with biochemical recurrence, they should choose treatment after considering their specific symptoms
.
MM patients are relatively sensitive to chemotherapy after the first relapse, and the treatment effect is better
.
For RRMM patients with multiple relapses, the multi-drug combination strategy is still a better choice
.
Relevant studies have shown that the therapeutic effect of the BCMA target is obvious, and even the RRMM patients with multidrug resistance can still get disease remission for up to 1-2 years
.
It is expected that CAR-T therapy and bispecific antibodies targeting BCMA can be marketed in China, bringing more benefits to the majority of MM patients
.
Professor Chen Wenming, Chief Physician, Professor, Doctor of Medicine, and Doctoral Supervisor, Director of the Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Director of Beijing Multiple Myeloma Medical Research Center, Director of the Department of Hematology, Capital Medical University, Consultant of the International Myeloma Working Group and China Multiple Myeloma Working Group Expert Committee Member of the Hematology Professional Committee of China Medical Education Association Member of the Standing Committee of the Hematology Branch of the Chinese Integrative Medicine Association Member of the Standing Committee of the Hematology Branch of the Chinese Society of Geriatrics Member of the Transplantation Group, Member of the Hematology and Tumor Branch of the Chinese Anti-Cancer Association
The theme of this conference is "Focus on Innovative Research, Leading the Original Future"
.
The conference continues to adhere to the fundamental purpose of CSCO, adopts new forms to actively carry out academic exchange activities in special periods, promotes academic exchanges and scientific and technological cooperation in the field of clinical oncology in China, encourages support for clinical research and innovation, and advocates multidisciplinary standardized comprehensive treatment based on Precision oncology actively promotes the development of the discipline
.
At this CSCO conference, Professor Chen Wenming from Beijing Chaoyang Hospital affiliated to Capital Medical University gave a theme report on "Treatment Progress in Relapsed and Refractory Multiple Myeloma (RRMM)".
Yimaitong organized the main contents as follows
.
Multiple myeloma (MM) is a malignant clonal plasma cell disease, accounting for about 10% of hematological malignancies
.
There is still no cure for MM, and relapse and refractory are the main clinical problems
.
Professor Chen Wenming first introduced the treatment and management of the first relapse and multi-line relapse of MM patients
.
For patients with MM who relapse for the first time, it is necessary to determine the timing of treatment, and choose a combination regimen based on nalidomide or bortezomib; for patients with multiple relapses, immunotherapy targeting the BCMA target can bring better results for patients.
Great benefit
.
The treatment and management of the first relapse of MM patients Since the market of thalidomide in 1999, 15 new drugs have been used in the treatment of MM
.
Professor Chen Wenming said that the application of new drugs usually accompanies the problem of relapse and refractory treatment, but not all relapsed MM need immediate treatment
.
It is needed when patients with relapsed MM have clinically advanced CRAB symptoms (increased blood calcium, renal damage, anemia, bone destruction) and rapid biochemical recurrence (high risk, accompanied by kidney or nerve damage, rapid increase in M protein) Treatment
.
When MM patients receive lenalidomide maintenance treatment and relapse after induction therapy, different treatment options can be selected according to the resistance of lenalidomide
.
The phase III POLLUX study included RRMM patients who had received at least one treatment regimen and were not resistant to lenalidomide, compared the Dara-Rd regimen (daratumumab, lenalidomide, dexamethasone) and The progression-free survival (PFS) of the Rd (lenalidomide, dexamethasone) regimen in the treatment of RRMM
.
The results of the study showed that the median PFS of the Dara-Rd regimen was 44.
5 months, and the median PFS of the Rd regimen was 17.
5 months; the Dara-Rd regimen had a very good partial remission and better remission (≥VGPR) rate of 81%, The ≥VGPR rate of the Rd scheme is 49%
.
The Dara-Rd regimen can be used as a treatment option for MM patients who have relapsed for the first time and are not resistant to lenalidomide
.
The Phase III CASTOR study compared the efficacy of Dara-Vd regimen (daratumomab, bortezomib, dexamethasone) and Vd regimen (bortezomib, dexamethasone) in the treatment of RRMM
.
The results of the study showed that the median PFS of the Dara-Vd regimen was 16.
7 months, and the median PFS of the Vd regimen was 7.
1 months; the ≥VGPR rate of the Dara-Vd regimen was 63%, and the ≥VGPR rate of the Vd regimen was 29%
.
The Dara-Vd regimen can also be used as a treatment option for RRMM patients
.
For RRMM patients who are resistant to both lenalidomide and bortezomib, carfilzomib and pomalidomide-based treatment options can be selected
.
The Phase III CANDOR study compared the Dara-Kd regimen (daratumomab, carfilzomib, dexamethasone) and the Kd regimen (carfilzomib, dexamethasone) in the treatment of patients who had previously received 1-3 therapies Efficacy of RRMM patients
.
The results of the study showed that the median PFS of the Kd regimen was 15.
8 months, and the median PFS of the Dara-Kd regimen was not reached; the ≥VGPR rate of the Dara-Kd regimen was 69.
2%, and the ≥VGPR rate of the Kd regimen was 48.
7%; treatment 12th At 6 months, the proportion of patients in complete remission (CR) with minimal residual disease (MRD) negative status in the two groups was 12.
5% and 1.
3%, respectively
.
The phase III APOLLO study compared the Dara-Pd regimen (daratumumab, pomalidomide, dexamethasone) and the Pd regimen (pomalidomide, dexamethasone) for treatment with at least one therapy (including Efficacy of RRMM patients with lenalidomide and proteasome inhibitor therapy
.
The median PFS of the Dara-Pd regimen and the Pd regimen were 12.
4 months and 6.
9 months, respectively; the ≥VGPR rate of the Dara-Pd regimen was 51%, and the ≥VGPR rate of the Pd regimen was 20%
.
The phase III OPTIMISMM study evaluated the efficacy of a three-drug combination regimen based on pomalidomide in RRMM patients who had previously received nallidomide treatment
.
The results of the study showed that compared with the Vd regimen, the PVd regimen (pomalidomide, bortezomib, dexamethasone) can significantly prolong the PFS of RRMM patients (median PFS: 11.
2 months vs 7.
1 months; P<0.
001)
.
For RRMM patients who failed the first-line treatment, the PVd regimen can significantly prolong the PFS compared with the Vd regimen (median PFS: 20.
73 months vs 11.
63 months; P=0.
0027)
.
Professor Chen Wenming said that for RRMM patients who relapse after maintenance treatment with lenalidomide and are not resistant to bortezomib, the PVd regimen is also a better treatment option
.
Principles of treatment for RRMM patients with multiple relapses RRMM patients with multiple relapses are currently mainly treated with CD38 monoclonal antibody combined with proteasome inhibitors and immunomodulators
.
However, because the median overall survival (OS) of RRMM patients will shorten with the increase in the number of drug resistance, conventional cytotoxic drugs and targeted drugs are not effective for patients with multiple relapses
.
In recent years, the emergence of chimeric antigen receptor T cell (CAR-T) immunotherapy, antibody-drug conjugates, bispecific antibodies and other new drugs and therapies targeting BCMA targets has brought many relapses to RRMM patients.
New hope for treatment
.
The BCMA CAR-T therapy idecabtagene vicleucel (ide-cel) has been approved by the FDA for the treatment of adult RRMM patients who have received at least 3 treatment options
.
Some antibody-drug conjugates have also been approved for the treatment of RRMM in European and American countries.
Among them, the overall response rate (ORR) of Belantamab Mafodotin monotherapy for RRMM is about 30%, and the ORR of combined pomalidomide and dexamethasone can be Up to 88%
.
The efficacy of XPO-1 inhibitor Selinexor in RRMM is also worthy of attention
.
The results of the Phase III BOSTON study showed that compared with the Vd regimen, the Selinexor combined with the Vd regimen can significantly prolong the PFS of RRMM patients (median PFS: 13.
93 months vs 9.
46 months; P=0.
0075)
.
In addition to bortezomib, Selinexor combined with pomalidomide, carfilzomib, CD38 monoclonal antibody and other drugs can also benefit RRMM patients
.
Bispecific antibodies also have considerable therapeutic prospects in RRMM
.
Related research results show that the humanized BCMA/CD3 bispecific antibody Teclistamab has an ORR of 65% for RRMM, a ≥VGPR rate of 58%, and a ≥CR rate of 40%
.
Summary Professor Chen Wenming concluded that: MM patients should avoid over-treatment, especially for patients with biochemical recurrence, they should choose treatment after considering their specific symptoms
.
MM patients are relatively sensitive to chemotherapy after the first relapse, and the treatment effect is better
.
For RRMM patients with multiple relapses, the multi-drug combination strategy is still a better choice
.
Relevant studies have shown that the therapeutic effect of the BCMA target is obvious, and even the RRMM patients with multidrug resistance can still get disease remission for up to 1-2 years
.
It is expected that CAR-T therapy and bispecific antibodies targeting BCMA can be marketed in China, bringing more benefits to the majority of MM patients
.
Professor Chen Wenming, Chief Physician, Professor, Doctor of Medicine, and Doctoral Supervisor, Director of the Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Director of Beijing Multiple Myeloma Medical Research Center, Director of the Department of Hematology, Capital Medical University, Consultant of the International Myeloma Working Group and China Multiple Myeloma Working Group Expert Committee Member of the Hematology Professional Committee of China Medical Education Association Member of the Standing Committee of the Hematology Branch of the Chinese Integrative Medicine Association Member of the Standing Committee of the Hematology Branch of the Chinese Society of Geriatrics Member of the Transplantation Group, Member of the Hematology and Tumor Branch of the Chinese Anti-Cancer Association
