Rob Miani joined the MMRF team as Chief Financial Officer in 2016. Most recently he was the Vice President of Finance and Corporate Controller of Aptuit, LLC, a global contract research organization providing integrated early discovery to mid-phase drug development services in the pharmaceutical industry. Rob has over 20 years of leadership experience in the private and public sectors, holding managerial positions in the renewable energy, private equity, Internet and technology industries, including Davenport Newberry, Oak Investment Partners and INT Media Group. He began his career with Arthur Anderson LLP in the Assurance and Business Advisory Services Division. Rob is a CPA and received his BS degree in Accounting from Fairfield University.
Answers to FAQs from our 3/8/23 webinar on Relapsed/Refractory Multiple Myeloma
If you are refractory to one drug in a class, are you automatically refractory to other drugs in that same class?
Myeloma patients who become refractory, or who stop responding, to a drug in a particular drug class are not automatically refractory to alternative drugs in the same class. For example, many patients may receive Revlimid as part of their initial treatment and may eventually stop responding to it. Revlimid-refractory patients can be switched to Pomalyst (another drug in the same class as Revlimid) and do well. And if Pomalyst stops working, there are other drugs in the same class that may be an option, such as mezigdomide or iberdomide, but these agents are currently only available as part of a clinical trial. Ultimately, agents in the same drug class work in slightly different ways, which is enough to kill myeloma cells.
Do treatments differ for patients who have high-risk cytogenetics?
There is no specific treatment used for patients with high-risk myeloma and this is an area of active research by myeloma clinicians. However, if a patient has high-risk cytogenetic abnormalities their doctor will typically treat them more aggressively than a standard-risk patient. For newly diagnosed patients, aggressive treatment would include: an induction regimen that has four drugs instead of three followed by an autologous stem cell transplant (if eligible) and maintenance therapy with more than one drug. Ultimately, the types of treatments depends on the which cytogenetic abnormalities a patient has and other risk factors.
For more information on treatment for high risk patients, please see our FAQ post here.
Which is the most up-to-date combination of therapies to use at first relapse for patients with either standard risk vs high risk disease?
The answer will depend on many key issues such as: 1) which treatment a patient had as their first treatment, 2) how well the patient responded to initial treatment, 3) what side effects were experienced, and 4) how long the patient responded to their initial treatment (or how aggressive the myeloma is). Treatment at first relapse will consist of a three-drug combination consisting of an immunomodulatory drug (Revlimid, Pomalyst), a proteasome inhibitor (Velcade, Kyprolis, Ninlaro), or an anti-CD38 monoclonal antibody (Darzalex, Sarclisa). Dexamethasone is also included as part of the three-drug regimen. The choice of the drug combination is going to depend on the key issues noted but also on patient-specific preferences such as convenience or distance from the medical center which may influence the choice to receive an intravenous versus an oral therapy. Patients should also consider a clinical trial.
