Diary from a Multiple Myeloma Conference

Guest post from Dr. Victor Profiteer

Once again, I am pleased to host Dr. Victor Kyprolis Profiteer, Multiple Myeloma expert writing from the LA Myeloma IMS conference. This is an except from his diary that he shared with me. If you like it, check out his last post about young oncology critics .

-vp

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—Dear Diary,

Victor Profiteer here. Why introduce myself in my own diary? Because I am a BFD. I’m a myeloma, key opinion leader. My ribbons are so long, they dangle in the toilet. Last year I earned more in consulting payments than my salary. I’m not conflicted because I take money from all the companies; they cancel each other out.

Today was a hum-drum day at the conference. It started with a vigorous discussion of how to boost 5 year survival. Some new-bee said we need better drugs. I had a good laugh. Then an arrogant doc from the Farber (doesn’t narrow it down, does it?) suggested we change the definition.

I had to remind them. “We already changed the definition!” We added slim criteria— knowing that some with skewed free light chains don’t progress over the next few years— ensuring over-treatment. This boosted 5 year survival in both myeloma and smoldering. Will Rogers was right, but wrong about where they moved to. They went to Boston, not California.

Another person said we need to diagnosis it earlier. Lead time is my jam. One colleague was worried. If we treat earlier with belantumab, some might go blind, she warned. Fortunately my friend from GSK shot back, “good news: the drug will stop working long before.” We cheered.

Lunch was meager. They had caviar and lobster, but it wasn’t the good kind. What is going on with IMS? Are we not taking enough money from Pharma to afford the good stuff? Here is our donors. Many companies are missing.

After lunch, someone asked if BCMA drugs might possibly maybe cause infection. OF COURSE THEY CAUSE LIFE-THREATENING INFECTIONS, but you can’t say that. Not here. It’s like cursing in church. Have some respect.

Someone asked if QUADS were the new standard of care. YEA, they are debatable only for MGUS. More drug, given sooner, forever, that is the mantra of myeloma.

I am running a phase 3 right now. Dara-KRd in healthy people. Primary endpoint: Time to MGUS. It's a noninferiority study run by the cooperative group. The secondary endpoint is OS, but don’t worry, we will cross everyone over by then. That’s our thing.

A young doctor was asking about OVERALL SURVIVAL. You can’t improve survival in myeloma. It's confounded or something like that; the drug rep explains it better than me.

It is far easier to invent an endpoint that has never established surrogacy— like MRD— and approve drugs that alter it. BTW, I don’t know if you know, but MRD doesn’t stand for minimal residual disease, it is measurable residual disease. And PFS doesn’t stand for progression free survival it is profit-full survival.

There was a session on cost of care in the afternoon. Obviously, no one attended. The parallel session was about why Denosumab was better than Zometa.

LA is a dump. We usually have this in good places like Vienna, Rio DeJaneiro, Rome, London, etc. Are we on a tight budget this year? I had to walk around and see homeless people that I never see at work— because my academic medical center refuses to see people without good insurance. In Vienna we got to party in a castle; here it is the rock and roll hall of fame or maybe a McDonalds, something like that, I forget.

Cure—Once again my colleague had to bring up cure. Look, if you define cure as a fixed course of therapy after which a person lives a full and normal life, then, myeloma is incurable. But if you define cure as taking lots of drugs forever, then myeloma is cured. Thankfully all my friends at BMS, Celgene, Sanofi and FDA agree that we need to re-define cure. If we can give drugs earlier to MGUS patients when they feel fine, then that is like a cure, right? Just think of time as moving backwards.

Side effects. Practice saying it with me, “no new side effects were identified” and “the regimen was tolerable.” That’s all you have to know.

CAR-T. Enough pessimism. Yes, I know CAR-T works well in other diseases— there is a long term durable fraction in dlbcl, for instance, but, in myeloma, every single person will relapse post-CAR-T. That just means they need another CAR, not that the CAR didn’t work. And the second CAR should cost another 400k. After all, that’s what the first CAR cost!

Combinations will cure myeloma. How do I know that? What else would you expect when no combination has ever done it before.

Let me take a selfie, another selfie, and another selfie. Humbled, honored, amazing, wonderful.

Masks are not needed IRL. Masks only needed for profile pics on twitter.

There are 3 parties to attend this evening; two hosted by pharma, and one hosted by the conference itself, so 3 are funded by pharma. The night will be so long that I cannot possible have time to write my own manuscripts. Look, life is about hard choices: either I write my own manuscripts or I attend a never-ending series of myeloma conferences and meetings over the year. Obviously that choice is clear.

What a long day! Gotta get some sleep before they pass out the lifetime achievement award tomorrow to the person with the most consulting payments. Then I have to do a video for a pharma funded oncology news site. Finally, a trip back to the airport in the Limo. What a way to finish the day!