Luciano Costa, MD, PhD
University of Alabama at Birmingham
Interview Date: April 16, 2018
Myeloma researchers are learning that the deeper our remissions, the better our outcomes (overall). Dr. Costa joins Myeloma Crowd Radio to share a key study for newly diagnosed multiple myeloma patients that includes four of the best myeloma therapies, a stem cell transplant and then variable maintenance based on the patient’s depth of remission. This is one of the first studies ever run in myeloma to give risk-adapted treatment to patients. The study uses a powerful four-drug combination: daratumumab, carfilzomib, lenalidomide and dexamethasone and then stem cell transplant. Following the transplant, patients are tested with a highly sensitive test (MRD test) that can detect one myeloma cell in a million. If patients still have remaining disease, they are given more rounds of the same four-drug combination.
To find this clinical trial on SparkCures, click here:
Dr. Costa on Myeloma Crowd Radio
Jenny: Welcome to today’s episode of Myeloma Crowd Radio, a show that connects patients with myeloma researchers. I’m your host, Jenny Ahlstrom. I would like to thank our episode’s sponsor, Celgene, for their support of Myeloma Crowd Radio. We’ve learned over the last few years that what patients do at the beginning of their treatment can really chart the course for their long-term outcome. And I learned about a study recently for newly diagnosed patients that I was so impressed with. On today’s show, we’ll be learning about this study. Not only does it use some of the best therapies in the myeloma arsenal today, it also looks at how patients respond to the therapy to know how long the maintenance or follow-up therapy should be. This is called risk-adapted therapy and it better personalizes myeloma care.
So with us today, we have the principal investigator on this clinical trial, Dr. Luciano Costa of the University of Alabama at Birmingham. Welcome, Dr. Costa.
Dr. Costa: Good morning. Thanks for having me here. It’s a pleasure to talk to you and a privilege to share some more information about our study with your audience.
Jenny: Oh, yes, it’s wonderful. We’re looking forward to it. Let me introduce you before we get started into questions. Dr. Luciano Costa is Medical Director for the Blood and Marrow Transplantation program and Associate Professor of Medicine in the Division of Hematology, Oncology and Transplantation at the University of Alabama at Birmingham. Dr. Costa received his medical degree and PhD in Brazil, his home country. He is Associate Editor of Advances in Cell and Gene Therapy and has published over 100 articles, books and posters on stem cell transplant in multiple myeloma. Dr. Costa’s research interests include strategies for stem cell transplant and population outcomes in blood cancers.
So again, we’re so happy to have you. Why don’t we start first with the general treatment landscape for newly diagnosed patients? When as things have evolved in treating myeloma, we have better drugs, we have more drugs. What are some common themes that patients may want to consider?
Dr. Costa: Absolutely. You’re absolutely right that myeloma treatment has evolved substantially in the last 20 years and that has clearly affected the newly diagnosed setting. That’s the one line of therapy that virtually every patient with myeloma goes through. However, just based on how new drugs are developed, it’s usually that’s where new drugs are less used. As a new drug has developed, it first gets its value proven in the relapsed setting and only subsequently in the newly diagnosed setting. So that is always a challenge because you can see new agents having very promising results in patients with relapsed myeloma and it takes sometimes five to ten years to see that new strategy or the new drug to help patients who are newly diagnosed.
But as you said, the current landscape of newly diagnosed patient is really dominated by a combination of immunomodulatory agents such as lenalidomide and proteasome inhibitors, particularly bortezomib. Patients who are not particularly old, and don have any significant cormobidity, do tend to integrate autologous transplant as part of the initial therapy. So I think if you do a survey throughout the country, the most commonly used strategy for newly diagnosed younger and fit patients tends to be the combination of bortezomib, lenalidomide and