Vincent Rajkumar Profile picture
Dec 14 13 tweets 4 min read
I just attended one of the biggest cancer meetings in the world. #ASH22 @ASH_hematology

For my followers here is a snapshot of the incredible progress happening with cancer treatment. It’s good. Thread.
1/ There is a revolution in cancer therapy that uses the power of our own immune system to fight cancer cells:

CAR-T cells
Bispecific antibodies

Both these approaches have already produced spectacular results in many cancers and we are just starting.
2/ CAR-T cells: take your own immune system cells out, engineer them to target a specific cancer, and then put them back in the body to go kill the cancer cells. A few CAR-T products have already been FDA approved. Many more to come.… Image
3/ Bispecific antibodies attach to immune system cells with one arm & cancer cells with the other, thereby bringing powerful immune system killer cells right next to the cancer cells. A few bispecific antibodies have been FDA approved. Many more to come.… Image
4/ There is a dramatic increase in understanding the mechanism of cancer due to massive increase in ability to sequence the tumor genes/proteins.

We are learning rapidly why cancer occurs, how it evolves, —- and importantly revealing new targets that we can go after with drugs.
5/ Multiple new small molecule targeted drugs are now available or are being developed as a result.
6/ Using molecular tools, we are able to classify cancers more accurately, diagnose better and faster. We are also able to assess the extent to which treatments have eradicated the tumor in a much better way: like be able to detect 1 cancer cell among a million normal cells. #MRD
7/ The possibility of using mRNA vaccine technology to fight cancer just got a boost. The idea of cancer vaccines has been around for a long time. But mRNA vaccine technology and personalization of the vaccine that it allows provides a lot of optimism…
8/ On a more general note, technology has connected investigators worldwide like never before making it much easier to collaborate. There is also a great willingness to collaborate across universities and countries.
9/ Video consults for patients and remote monitoring of treatment relate side effects were accelerated as a result of COVID. This means now that patients can consult experts more easily, and can receive more of their cancer care at home than in a hospital.
10/ I am also totally impressed by the talent of the next generation of investigators. These are some brilliant people who are driven to find ways of improving outcomes in cancer.
11/ Clearly many challenges lie ahead: The cost of these new drugs, the strain on the healthcare system that the complexities of administering new immunotherapy treatments brings, the cost and time it takes to do the necessary clinical trials, etc.
12/ But all in all progress against cancer is accelerating fast. Some cancers may be cured as a result and in many cancers we will be able to control cancer and extend survival significantly longer due to these advances.

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More from @VincentRK

Dec 10
Updated Myeloma Treatment Algorithms presented at @IMFmyeloma @CCO_Education symposium today at #ASH22

1. Newly diagnosed transplant ineligible. Either VRd or DRd is OK. Maintenance varies by risk stratification.
2. Newly Diagnosed myeloma transplant eligible. #ASH22

Early transplant preferred. But for selected standard risk patients depending on preference, delayed is also OK. Maintenance varies by risk stratification.
3. First relapse. The approach depends on refractoriness to Len and CD38moAB. For CD38 Moab either Daratumumab or Isatuximab are OK. Depends on cost and availability. #ASH22
Read 7 tweets
Dec 8
At #ASH22 my colleague @myelomaMD will present the initial results of the ASCENT trial, aka the 2nd Cure trial to test the hypothesis whether myeloma can be cured if highly active combination therapy is given early at the smoldering myeloma stage.… Image
Updated results from the 1st Cure trial, GEM-CESAR led by @mvmateos is also being presented at #ASH22…
These trials are part of a planned series of trials investigating whether the incurability of myeloma is related to the fact that we have traditionally started effective therapy only after the disease has spread and mutated to the point where it is no longer curable.
Read 9 tweets
Dec 7
Just in time for #ASH22

The IMWG updated diagnostic criteria for myeloma & related disorders has just become the most cited myeloma paper ever. @TheLancetOncol #MedTwitter…

I was honored to lead this effort for the IMWG. A thread on the main changes.
2/ The paradigm shifting change was including 3 biomarkers that were associated with 80% or greater probability of progression within 2 years as myeloma defining events on top of CRAB.

>100 myeloma experts gave input for the paper. #ASH22 #MedTwitter Image
3/ We simultaneously updated the diagnostic criteria for related plasma cell disorders including MGUS, SMM, and solitary plasmacytoma. Image
Read 13 tweets
Dec 5
Ahead of #ASH22 here are my updated algorithms for current treatment of myeloma. ImageImageImageImage
Algorithm for second or higher relapse: Any of the first relapse regimens which contains at least 2 drugs the patient is not refractory to.

For refractory myeloma see below. Image
It’s a complicated landscape and I have tried to make it simple for practicing clinicians.

There are changes compared to prior years. @mtmdphd @Mohty_EBMT #MedTwitter Image
Read 5 tweets
Dec 3
Here are my Top 5 #ASH22 @ASH_hematology myeloma abstracts. #ASH22VR
Links to the full abstract. As in the past, I left out studies where similar results were already presented or published before. Top 5 based on new data, clinical impact & methodology

Thread with countdown👇
#5 Not everyone with MGUS diagnosis needs a marrow. Choosing wisely. The iStopMM trial provides a model that limits unnecessary bone marrow biopsies. #ASH22 #ASH22VR @sykristinsson @eliaseythorsson @SaemundurMD @SigrunThorstei1…
#4 Defining duration of maintenance therapy. Brilliant analysis of Myeloma XI trial. Benefit persists for 3 yrs. But 4-5 yrs after starting maintenance, benefit diminishes. Lot more insights. #ASH22 #ASH22VR @_DrCP @profghjackson @profBigG @DrGarethMorgan1…
Read 8 tweets
Dec 3
The COVID story of the last 3 years. Cases versus Deaths. ImageImage
All countries eventually abandoned the precautions that helped them control COVID. Which led to massive spike in cases especially with more transmissible omicron variants.

But a huge number of lives were saved by controlling COVID until the public was well vaccinated.
The idea that everyone will get COVID eventually and precautions to prevent spread of COVID didn’t matter is wrong.

Controlling COVID until after the public is well vaccinated did save a huge number of lives. Lives saved largely remained lives saved.
Read 5 tweets

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