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• Pomalidomide plus lowdose dexamethasone significantly improved PFS vs pomalidomide alone in relapsed and refractory multiple myeloma.• Pomalidomide plus low-dose dexamethasone is an important new treatment option for RRMM patients who have received multiple prior therapies.This multicenter, open-label, randomized phase 2 study assessed the efficacy and safety of pomalidomide (POM) with/without low-dose dexamethasone (LoDEX) in patients with relapsed/refractory multiple myeloma (RRMM). Patients who had received ‡2 prior therapies (including lenalidomide [LEN] and bortezomib [BORT]) and had progressed within 60 days of their last therapy were randomized to POM (4 mg/day on days 1-21 of each 28-day cycle) with/without LoDEX (40 mg/week). The primary end point was progression-free survival (PFS). In total, 221 patients (median 5 prior therapies, range 1-13) received POM1LoDEX (n 5 113) or POM (n 5 108). With a median follow-up of 14.2 months, median PFS was 4.2 and 2.7 months (hazard ratio 5 0.68, P 5 .003), overall response rates (ORRs) were 33% and 18% (P 5 .013), median response duration was 8.3 and 10.7 months, and median overall survival (OS) was 16.5 and 13.6 months, respectively. Refractoriness to LEN, or resistance to both LEN and BORT, did not affect outcomes with POM1LoDEX (median PFS 3.8 months for both; ORRs 30% and 31%; and median OS 16 and 13.4 months). Grade 3-4 neutropenia occurred in 41% (POM1 LoDEX) and 48% (POM); no grade 3-4 peripheral neuropathy was reported. POM1LoDEX was effective and generally well tolerated and provides an important new treatment option for RRMM patients who have received multiple prior therapies. This trial was registered at www.clinicaltrials.gov as #NCT00833833. (Blood. 2014;123(12):1826-1832 Introduction Virtually all patients with multiple myeloma (MM) eventually relapse. Relapsed disease is characterized by increasingly shorter periods of remission following each salvage therapy.1 Survival among MM patients in whom novel agents (including bortezomib [BORT], lenalidomide [LEN], and/or thalidomide) have failed is especially poor.2 There is a clear unmet need for new treatments, particularly for patients who are relapsed and refractory to novel agents.Pomalidomide (POM) is a distinct immunomodulatory drug with potent antimyeloma activity.3-5 POM plus dexamethasone (DEX) has synergistic antiproliferative effects in LEN-resistant myeloma cells. 6 The activity of POM in cells resistant or refractory to LEN may be due to important differences in both the potency of the drugs and their respective mechanisms of action. 3,[7][8][9][10][11] POM has demonstrated efficacy in patients with relapsed/ refractory MM (RRMM) who had received multiple prior therapies, either when given alone [12][13][14] or with low-dose DEX (LoDEX). 14-17Here, we report the results of a multicenter, randomized, open-label, phase 2 trial. The phase 1 part of the study established the maximum tolerated dose of POM (4 mg/day on days 1-21 of a 28-day cycle). 18The phase 2 part evaluated the efficacy and s...

Key Points Twice-weekly oral ixazomib appears tolerable, with no severe neuropathy seen to date, in heavily pretreated multiple myeloma patients. These phase 1 data suggest clinical activity including 76% stable disease or better, with durable responses and sustained disease control.

Moffitt Cancer Center.

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Well‐defined adaptative and amphiphilic polymer conetworks based on hydrophilic poly(N,N‐dimethylamino‐2‐ethyl methacrylate) (PDMAEMA) and hydrophobic poly(ε‐caprolactone) (PCL) have been prepared by combination of ATRP, ROP, and “Click chemistry.” Telechelic α,ω‐alkyne terminated PCL crosslinker was obtained by ring‐opening polymerization (ROP) of CL in THF at 80 °C initiated by 1,4‐butanediol and catalyzed by tin(II) bis 2‐ethyl hexanoate (Sn(Oct)2), followed by the quantitative esterification of hydroxyl end‐groups by activated 4‐pentynoic acid. In parallel, an azido‐containing PDMAEMA‐based copolymer was obtained in a three‐step strategy involving primarily the copolymerization of DMAEMA with newly synthesized 2‐(2‐azidoethoxy)ethyl methacrylate (AEEMA) monomer. The latter was obtained by nucleophilic substitution of chloride atom from 2‐(2‐chloroethoxy)ethanol by an azide group followed by the esterification reaction of the hydroxyl group with methacrylic anhydride. The copolymerization was carried out in an equivolumic mixture of H2O and isopropanol at r.t. and initiated by a ω‐bromoisobutyryl oligo PEO macroinitiator in the presence of various ligated copper(I)‐based catalysts. In a last step, both polymer precursors were chemically linked by the Huisgen‐1,3‐dipolar cycloaddition in anhydrous THF at r.t. using CuBr complexed by 2,2′‐bipyridine ligand as catalyst. Final material was characterized by the means of DSC and SEM, both attesting of a homogeneous distribution of the PCL crosslinkers and a highly porous structure in this new amphiphilic model conetworks. © 2008 Wiley Periodicals, Inc. J Polym Sci Part A: Polym Chem 46: 4997–5013, 2008

Key Points• Isatuximab (anti-CD38 monoclonal antibody) given with lenalidomide/ dexamethasone is active in heavily pretreated relapsed/ refractory myeloma • Overall, the safety profile of this combination is similar to the characteristic safety profiles of the individual agents. remained on treatment at data cutoff. Isatuximab-lenalidomide-dexamethasone was generally well tolerated with only 1 dose-limiting toxicity reported (grade 3 pneumonia at 20 mg/kg QW/ Q2W); the MTD was not reached. The most common isatuximab-related adverse events were infusion-associated reactions (IARs) (56%), which were grade 1/2 in 84% of patients who had an IAR and predominantly occurred during the first infusion. In the efficacy-evaluable population, the overall response rate (ORR) was 56% (29/52) and was similar between the 10 mg/kg Q2W and 10 and 20 mg/kg QW/Q2W cohorts. The ORR was 52% in 42 evaluable lenalidomide-refractory patients. Overall median progression-free survival was 8.5 months. Isatuximab exposure increased in a greater than dose-proportional manner; isatuximab and lenalidomide pharmacokinetic parameters appeared independent. These data suggest that isatuximab combined with lenalidomide and dexamethasone is active and tolerated in heavily pretreated patients with RRMM. This trial was registered at www.clinicaltrials.gov as #NCT01749969. (Blood. 2017;129(25):3294-3303)

Purpose Selinexor, a first-in-class, oral, selective exportin 1 (XPO1) inhibitor, induces apoptosis in cancer cells through nuclear retention of tumor suppressor proteins and the glucocorticoid receptor, along with inhibition of translation of oncoprotein mRNAs. We studied selinexor in combination with low-dose dexamethasone in patients with multiple myeloma refractory to the most active available agents. Patients and Methods This phase II trial evaluated selinexor 80 mg and dexamethasone 20 mg, both orally and twice weekly, in patients with myeloma refractory to bortezomib, carfilzomib, lenalidomide, and pomalidomide (quad-refractory disease), with a subset also refractory to an anti-CD38 antibody (penta-refractory disease). The primary end point was overall response rate (ORR). Results Of 79 patients, 48 had quad-refractory and 31 had penta-refractory myeloma. Patients had received a median of seven prior regimens. The ORR was 21% and was similar for patients with quad-refractory (21%) and penta-refractory (20%) disease. Among patients with high-risk cytogenetics, including t(4;14), t(14;16), and del(17p), the ORR was 35% (six of 17 patients). The median duration of response was 5 months, and 65% of responding patients were alive at 12 months. The most common grade ≥ 3 adverse events were thrombocytopenia (59%), anemia (28%), neutropenia (23%), hyponatremia (22%), leukopenia (15%), and fatigue (15%). Dose interruptions for adverse events occurred in 41 patients (52%), dose reductions occurred in 29 patients (37%), and treatment discontinuation occurred in 14 patients (18%). Conclusion The combination of selinexor and dexamethasone has an ORR of 21% in patients with heavily pretreated, refractory myeloma with limited therapeutic options.