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ASH 2024 | Venetoclax in patients with multiple myeloma with or without t(11;14): a real-world analysis
Edward Cliff, MPH, MBBS, Peter MacCallum Cancer Centre, and Royal Melbourne Hospital, Melbourne, Australia, discusses a real-world analysis of venetoclax treatment outcomes in patients with multiple myeloma (MM) with or without the t(11;14) translocation. Dr Cliff highlights that, despite two negative randomized controlled trials, this real-world study using electronic health record data confirms the biological rationale for venetoclax use in patients with t(11;14) and highlights the promising activity observed when combined with other agents. This interview took place at the 66th ASH Annual Meeting and Exposition, held in San Diego, CA.
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Transcript
Viewers will know that venetoclax in myeloma has been a bit of a torrid story. There have in fact been now two negative randomized controlled trials. First, the BELLINI trial, which looked at all patients with myeloma, not just those with translocation 11;14, and then the most recently presented CANOVA study, which looked just at patients with translocation 11;14. Unfortunately, both of those trials were negative, and there was in fact an overall survival decrement in the BELLINI study thought to be due to infectious toxicity events...
Viewers will know that venetoclax in myeloma has been a bit of a torrid story. There have in fact been now two negative randomized controlled trials. First, the BELLINI trial, which looked at all patients with myeloma, not just those with translocation 11;14, and then the most recently presented CANOVA study, which looked just at patients with translocation 11;14. Unfortunately, both of those trials were negative, and there was in fact an overall survival decrement in the BELLINI study thought to be due to infectious toxicity events.
However, there clearly is clinical activity and so there’s still a lot of work underway in the myeloma community to try and work out the best use of agents like venetoclax and the newer sonrotoclax which remains in clinical trials. And so we conducted a real-world study using the Flatiron health database which is collected through electronic health records of about 200, a bit over 200, 208 patients with multiple myeloma receiving venetoclax.
And what we found was that about 70%, just over 70% of those had translocation 11;14 and that over time that increased, that in more recent years, mostly people are using venetoclax in t(11;14). We also found that the outcomes, the time to next treatment and overall survival in patients who were receiving venetoclax were better in those with t(11;14) which supports the kind of biological hypothesis, biological rationale for that use. And we found that venetoclax when it was used in combinations had more durable time-to-next treatment, and so although it was used a fair bit as a single agent or just with dexamethasone, in fact when it was used in combination with other agents it had a more promising activity.
And so I think this supports the ongoing study of venetoclax in t(11;14) myeloma it’s just going to be about finding the right group of patients, the right combination of treatment, the right dosing and the right disease context. So I think reassuring but still definitely more clinical trial data needed to ensure that this is a safe treatment as well as an effective one.
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