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Ben Derman Profile picture
@bdermanmd
Jun 2 • 11 tweets • 6 min read Twitter logo Read on Twitter
Are you ready for an #ASCO23 myeloma megathread? Here are 10 important abstracts to tune into to learn more (esp. with so little data in the abstract!). Let's go! #mmsm
Abstract 8000: Elo-KRd vs. KRd induction showed sig. improvement in MRD-neg rate (50% vs 35%) at end of induction. Long-term f/u + PFS data will be key. Might there be something about Elo and K synergy? Would this allow for using anti-CD38 mAb later? meetings.asco.org/abstracts-pres…
Abstract 8002: Teclistamab + talquetamab in RRMM.
➡️63 pts, 33% HR cyto, 78% triple-class refract., 43% extramed. dz.
⏲️14.4 mos f/u
🚨ORR 84% (73% in EMD)
🛟81% CRS (3% G3), 1 ICANS, 2 DLTs
Impressive ORR - what is durability? Better than sequential?
meetings.asco.org/abstracts-pres…
Abstract 8004: Phase I study of PHE885 CAR T
Shameless plug for @adamssperling's pres!
⏳Vein-to-vein 16 days
🚨Only 28% required bridging
⏲️7/12 (71%) had transgene @ 1yr
👍ORR 98%; durable responses
💭Quick turnaround time to make CAR T more accessible?
meetings.asco.org/abstracts-pres…
Abstract 8005: Updated Phase I GC012F BCMA/CD19 CAR T.
#⃣29 pts
👍93% ORR, sCR/MRD-neg 83%.
👍Median PFS and DOR 38 months
⏲️55% with detectable transgene at 12 months
💭Durability is quite impressive. Need to see what happens with more patients!
meetings.asco.org/abstracts-pres…
Abstract 8009: Final results of CARTITUDE-1 (cilta-cel) (@YiLinMDPhD)
‼️ 18/97 (19%) MRD-neg + CR at 24 months
👍 median PFS now 34.9 months; 30yr PFS 47.5%
⚠️6 new SPM, incl. 1 MDS and 1 lymphoma.
💭This is the real deal. Amazing advance for pts.
meetings.asco.org/abstracts-pres… Image
Abstract 8012: Real-world safety/efficacy with Cilta-cel.
⚠️19% out of spec (i.e. EAP).
⚠️9% delayed neurotox
👍ORR 80% (89% in non-EAP).
💭It is still too early to make heads or tails of the effectiveness with such short follow-up. (median 2.3 mos.)
meetings.asco.org/abstracts-pres…
Abstract 8051: Outcomes in primary refractory MM
➡️7% in mayo cohort had primary refractory MM
⚠️Median PFS2 12 months (yikes)
👍Pts who received 2nd line ASCT had increased PFS2 (21 vs 8 mos.) & OS
💭 ASCT pts prob. more fit but supports ASCT in 2nd line
ascopubs.org/doi/abs/10.120…
Abstract 6574: Incidence of reactions with SQ dara after omission of premeds
Another shameless plug @UCCancerCenter!
➡️We compared rxns with or w/out premeds starting w/C2 of SQ dara.
👍No reactions seen in either arm. 194 pt hrs saved!
#PuntThePremeds
meetings.asco.org/abstracts-pres…
8007: Belantamab mafodotin vs Pd in RRMM
➡️Yes, we know it was a negative study with nonsignificant PFS diff (median 11.2 vs 7 months).
💭PFS2 of 18.7 months vs 12.7 months is interesting. Is it a fluke or a real signal?
meetings.asco.org/abstracts-pres…
And last but not least - really looking forward to @bhemato presenting on CARTITUDE-4!
Surely will generate some great discussion!
meetings.asco.org/abstracts-pres…

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More from @bdermanmd

Ben Derman Profile picture
Dec 7, 2022
I get asked all the time: Can MRD status guide treatment decision in myeloma?
📜A separate thread dedicated to #ASH22 studies investigating #mmMRD-guided management in myeloma.
I will post lots more about our MRD2STOP study as we get closer to the conference! #mmsm
Abstract 992 (@kordeneha1):
The premise: Patients with 3+ years of MRD-neg (flow, 10^-5 to 10^-6) undergo discontinuation of maintenance. Monitored q6mos bone marrow (flow), yearly PET.
n=23
👍Sustained MRD-neg at 12 months: 14/16 (88%)
👍12 month PFS: 94%
ashpublications.org/blood/article/… Image
Abstract 3237 (@End_myeloma) Update from MASTER trial (MRD-Adapted Dara-KRd + ASCT):
#⃣84 pts in treatment-free surveillance, f/u ~24 mos.
👉8% MRD resurgence, 13% disease progression
☀️79% still off treatment
⚠️Only 47% of ultra-high risk pts off therapy
ash.confex.com/ash/2022/webpr… Image
Read 6 tweets
Ben Derman Profile picture
Dec 5, 2022
So many excellent #ASH22 abstracts to choose from. Sharing my thoughts on 11 important works, with more to come as we get closer to the meeting! In order of abstract number (not merit)...let's go! #mmsm
158: Elrantamab in R/R MM to be presented by @NoopurRajeMD.
☀️27% Black or asian enrollment
☀️ 24% with prior BCMA-dir therapy
👉ORR 64% (38% CR+)
🚨7/13 (54%) ORR w/prior BCMA-dir therapy. This is the important take home!
⏳Duration of response 17 months
ash.confex.com/ash/2022/webpr…
160: MajesTEC-2: Teclistamab/Len/Dara (Searle).
n=32; f/u 6 months. Median 2 prior lines. 31% anti-CD38 exposed.
⚠️Infections 75% (respiratory). CRS 81% (gr 1-2)
🚨 ORR 100% (VGPR 12/13).
So important to establish whether bispecifics can play nice with other myeloma therapies.
Read 12 tweets
Ben Derman Profile picture
May 20, 2020
So many great abstracts to peruse for #ASCO20. Some themes: weekly regimens, anti-BCMA therapies, MRD, & high-risk disease. By abstract #, here are 10(ish) #ASCO20 abstracts that stood out to me for their clinical relevance and intrigue. Long thread incoming! #mmsm #ASCO20BD /1
Plenary LBA3: KRd vs. VRd. No data yet until May 28, but this will be relevant no matter what the outcome is! Note that most high-risk patients were not included in this study. Don't think we'll have a final answer on this debate though! meetinglibrary.asco.org/record/186906/… #mmsm #ASCO20BD /2
#100: Phase I trial of Teclistamab, a bispecific BCMA x CD3 T-cell engager, showed reasonable rates of CRS (56%, all <grade 3). ORR was 38% at doses >38.4 ug/kg. 7/9 (78%) responded at highest dose (2 were CR + MRD-neg at 10^-6). #mmsm #ASCO20BD meetinglibrary.asco.org/record/186864/… /3
Read 12 tweets
Ben Derman Profile picture
Oct 27, 2019
Exciting to see results of lenalidomide in smoldering myeloma. It’s clear that lenalidomide prolongs time to progression and to symptomatic disease. I will point out reasons why I am not ready to use this regimen for smoldering myeloma. [thread] #mmsm ascopubs.org/doi/full/10.12…
1) Lead time bias. Not surprising that treating pts earlier will delay progression. We are treating them! We have to think beyond progression too!
2) Only 11/90 pts in placebo arm experienced bony disease and 8/90 renal failure at progression. Also we don’t know severity! #mmsm
3) Many pts discontinued lenalidomide. 30/92 because of adverse events and 22/92 because of withdrawal/refusal. Similar to experience with maintenance, this drug is not always easy for patients!
4) HRQOL wasn’t worse with Len, but it also wasn’t better despite ⬆️ PFS
#mmsm
Read 8 tweets
Ben Derman Profile picture
May 6, 2019
Elevated PTT is one of my favorite types of consults, but I think there are a few things that every clinician should assess before consulting:
(1) Is the patient on heparin? If yes, there's your answer :)
(2) No, really, is the patient receiving heparin? Hep Lock, etc.
... #MedEd
...An elevated thrombin time might give you the answer.
(3) Send a PTT mixing study! It's easy, and gives you lots of info! The patient's plasma is mixed with normal plasma. If the PTT fully corrects to normal, it's
a factor deficiency. Partial correction = inhibitor. #MedEd
...(3a) If an inhibitor: It could either be due to lupus anticoagulant or a factor inhibitor. The most common inhibitor is to factor 8.
(3b) If deficiency: I like to start with levels for factor 8, 9, and 11, which would account for most cases of isolated PTT elevation. #MedEd
Read 4 tweets

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