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December 13, 2021updated 07 Jan 2022 6:47am

ICR team identifies combination of five drugs for bone marrow cancer

In the trial, 82% of the subjects were found to have stable disease at 18 months, which was unlikely to advance soon.

The Institute of Cancer Research (ICR), London in the UK has reported that a cocktail of five current drugs demonstrated to be effective to treat people with a highly aggressive type of bone marrow cancer in the MUK Nine OPTIMUM trial.

The combination treatment comprised bortezomib, lenalidomide, daratumumab, dexamethasone and cyclophosphamide chemotherapy, which are licensed separately and currently in clinical use.

Findings showed that the five-drug combo, together with a stem cell transplant, was demonstrated to offer prolonged time for ultra-high risk multiple myeloma patients before disease progression versus those treated with standard of care therapies.

The trial is the latest to show the effectiveness of combination therapies with varying mechanisms of action to fight the ability of cancer to evolve and become drug-resistant.

An ICR team and the University of Leeds’ Clinical Trials Research Unit deployed a new high-speed trial methodology to test the drug cocktail against the data from the prior trial.

The OPTIMUM ‘digital comparator’ trial enrolled 107 subjects with ultra-high-risk myeloma between 2017 and 2019.

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The results compared survival outcomes from subjects in the OPTIMUM trial treated with a five-drug cocktail to those in the Myeloma XI (MyXI) trial treated with carfilzomib, lenalidomide, cyclophosphamide and dexamethasone.

Subjects in the OPTIMUM trial were found to live for an extended duration during and after the combination treatment before disease progression and worsening of symptoms versus subjects in the MyXI trial.

Furthermore, 82% of the patients in OPTIMUM had stable disease at 18 months, which was unlikely to advance in the near future versus 67% of MyXI participants.

The trial obtained funds from Janssen and Bristol Myers Squibb that produce the drugs analysed in the trial.

ICR London Myeloma Molecular Therapy team leader Dr Martin Kaiser said: “Our study shows the benefit of genetic testing in patients with myeloma to identify those at highest risk since we now have a new and better treatment option for these people.

“All these drugs are already individually licensed and available so we know they are safe, and that means the new combination could potentially be made available for patients quickly.”

People with ultra-high-risk multiple myeloma possesses unfavourable genetic signatures and are at greater disease relapse risk within the first two years after detection.

This September, ICR reported that a new combination of targeted drugs was found to be effective in tumour shrinkage in half of the people with low-grade serous ovarian cancer in the Phase I FRAME trial.

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