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    Home > Active Ingredient News > Blood System > 2021 IMW Expert Interview|Professor Bao Li: There are still challenges in the treatment of elderly MM, and new drug solutions are worthy of further exploration

    2021 IMW Expert Interview|Professor Bao Li: There are still challenges in the treatment of elderly MM, and new drug solutions are worthy of further exploration

    • Last Update: 2021-10-11
    • Source: Internet
    • Author: User
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    The 18th International Myeloma Symposium (IMW) in 2021 will be held simultaneously in Vienna, Austria and online on September 8-11, 2021.
    The conference is hosted by the International Myeloma Society (IMS) and is dedicated to the promotion of multiple myeloma ( MM) and the latest breakthrough scientific and clinical communication on plasma cell diseases
    .

    At this IMW conference, the team of Professor Li Bao from Beijing Jishuitan Hospital announced the results of a study comparing the three-drug combination regimen in the treatment of elderly patients with MM
    .

    Yimai Tongcheng has the honor to invite Professor Bao Li to share on the current status and prospects of the treatment of elderly MM
    .

    Yimaitong: First of all, could you please introduce the current status of the treatment of elderly MM, what are the unmet treatment needs of elderly MM patients? Professor Bao Li MM is a senile disease.
    The median age of onset in European and American countries is 69 years old
    .

    Due to the low emphasis on elderly MM patients in China and many elderly MM patients have not been diagnosed, the median age of onset of MM patients in China is lower than the level reported abroad
    .

    However, with the gradual extension of life expectancy in China, the incidence of MM patients is gradually increasing, and the median age of onset is gradually approaching the level of European and American countries
    .

     At present, elderly patients with MM still have some unmet needs for treatment
    .

    First of all, although MM patients are older and some patients are over 80 years old, most MM-related clinical trials currently only enroll MM patients aged 18-75 years old.
    Therefore, elderly MM patients older than 75 years old have access to new drugs.
    It is much lower than that of young MM patients, and some elderly patients are in relatively good physical condition, but the prognosis cannot be further improved through the treatment of clinical trials
    .

    Secondly, there are relatively more complications in elderly MM patients, and some patients may be affected by other diseases such as Alzheimer's disease
    .

    The medication of these patients is more complicated, and there are also certain deficiencies in home care, resulting in insufficient treatment and poor compliance with treatment
    .

     Since most of the current MM-related clinical trials exclude elderly patients, and elderly MM patients have poor clinical compliance, many clinicians also lack sufficient experience in the treatment of elderly MM
    .

    At present, the treatment of elderly MM is generally relatively conservative, and most of them only use palliative treatment, which leads to the general inadequate treatment of elderly MM patients in China.
    Therefore, the prognosis of elderly MM patients in China is relatively worse than that of European and American countries
    .

    Yimaitong: At this IMW conference, your team announced the results of a study on the treatment of elderly MM patients with an IAd regimen versus IRd regimen.
    Could you please introduce the efficacy and safety of the two treatment options in elderly MM patients? how? Professor Bao Li at this IMW conference, we announced a comparison of two three-drug combination regimens for the treatment of elderly (age> 65 years old) and poor physical condition (IMWG frailty score> 2 or Mayo Clinic Frattyy score for frailty) The results of the study of newly treated MM patients
    .

     A total of 95 patients were enrolled in the study, with a median age of 71 years (range: 65-88), and 29.
    5% of patients were older than 75 years
    .

    In the study, patients received IAD regimen (Isazomib, doxorubicin liposomes, dexamethasone) and IRD regimen (Isazomib, lenalidomide, dexamethasone)
    .

    Since the IRD regimen includes lenalidomide, all elderly patients with MM with renal impairment and large masses were included in the IAD group
    .

     The results of the study show that the efficacy of the two three-drug combination regimens is similar
    .

    At a median follow-up of 10 months (range: 1-20), the overall response rate (ORR) of all patients was 80.
    9%, of which the ORR of the IAd group was 80.
    9% and the IRd group was 81.
    0%
    .

    The median progression-free survival (PFS) of the IAd group was 16 months, and the median PFS of the IRd group was not reached
    .

    The median overall survival (OS) of the two groups of patients was not reached, and the 12-month OS rate was 81.
    0%
    .

     The safety of the two three-drug combination scheme is good
    .

    9.
    5% of patients had hematological adverse events (AE) ≥ grade 3, 13.
    7% of patients had gastrointestinal AEs ≥ grade 3, and 13.
    7% of patients had pneumonia
    .

    The incidence of neurotoxic AEs in the IRd group was higher
    .

     Overall, compared with younger patients or older MM patients with better physical conditions, elderly MM patients with poor physical conditions still have poorer efficacy
    .

    The efficacy and safety of the three-drug combination in this study are consistent with the results of previous related studies, and it is suitable as a first-line treatment option for elderly MM patients with poor physical conditions
    .

    Yimaitong: Given that the mortality rate of middle-aged and elderly MM patients in this study is still relatively high, how do you think we should further explore combined treatment options to improve the prognosis of elderly MM patients? Professor Bao Li 16 patients died in the study, of which 7 patients died of disease progression, and 4 patients died early (≤60 days)
    .

    The early mortality rate of elderly patients with MM is indeed higher, mainly due to two reasons
    .

    First of all, the basic condition of the elderly MM patients included in the study is poor.
    Most of the patients have comorbidities, and some patients died early due to the comorbidities
    .

    Secondly, most of the elderly MM patients in the study underwent second-generation sequencing.
    The test results showed that most of the patients were at high risk of cytogenetics.
    The efficacy of the three-drug combination regimen in this part of the patients was not good, and the early mortality rate was therefore higher.

    .

     Due to the relatively poor physical condition of elderly MM patients, there are fewer medication opportunities compared to young MM patients, and it is difficult to undergo multi-line treatment
    .

    In addition, due to the higher cytogenetic risk of elderly patients with MM, the common two-drug combination or palliative treatment has a poorer survival prolongation effect
    .

    Therefore, for newly treated elderly MM patients, a single palliative treatment plan should be avoided in the first-line treatment, and new drug combinations such as daratumumab and lenalidomide should be considered as much as possible to bring better efficacy and prognosis for elderly MM patients
    .

    Yimaitong: What are your prospects for the future treatment of elderly MM? Professor Bao Li elderly patients is the current difficulty in the treatment of MM, and it is also the focus of treatment
    .

    Although relevant foreign studies are currently exploring treatment options for elderly MM, related treatment options are usually not suitable for MM patients with poor physical conditions
    .

    At present, there are still fewer treatment options for elderly and poor MM patients.
    It is still necessary to carry out more clinical studies to explore better treatment options for these patients
    .

     In addition, the treatment of elderly MM still needs to try more new drugs, such as daratumomab, ixazomib, dexamethasone, Selinexor, etc.
    , to further prolong OS
    .

    We look forward to more clinical studies in the future to explore the efficacy of these new drug combinations in elderly MM patients, accumulate more clinical experience, bring more active and effective treatment options for elderly MM patients, and improve the prognosis of these patients
    .

    Reference materials: Li Bao, et al.
    2021 IMW.
    P-160.
    Professor Bao Li, Director and Chief Physician, Department of Hematology, Beijing Jishuitan Hospital, Chairman, Committee of Hematology, Beijing Perioperative Medical Research Association, Vice Chairman, Myeloma Branch, Chinese Medical Education Association Standing member of the Hematology Branch Committee of the Chinese Society of Chinese Medicine Members of the Beijing Municipal Science and Technology Commission’s medical and health expert database members stamp "read the original text", we will make progress together
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