Perifosine plus lenalidomide and dexamethasone in relapsed and relapsed/refractory multiple myeloma: a Phase I Multiple Myeloma Research Consortium study.

The combination of lenalidomide-dexamethasone is active in multiple myeloma (MM). Preclinical data showed that the Akt inhibitor, perifosine, sensitized MM cells to lenalidomide and dexamethasone, providing the rationale for this Phase I, multicentre, single-arm study to assess the safety and determine the maximum-tolerated dose (MTD) of perifosine-lenalidomide-dexamethasone in relapsed and relapsed/refractory MM. Patients received escalating doses of perifosine 50-100 mg daily and lenalidomide 15-25 mg once daily on days 1-21 of each 28-d cycle, plus dexamethasone 20-40 mg weekly thereafter, as indicated. Thirty-two patients were enrolled across four dose cohorts. MTD was not reached, with 31 patients evaluable for safety/tolerability. The most common all-causality grade 1-2 adverse events were fatigue (48%) and diarrhoea (45%), and grade 3-4 neutropenia (26%), hypophosphataemia (23%), thrombocytopenia (16%), and leucopenia (13%). Among 30 evaluable patients, 73% (95% confidence interval, 57·5-89·2%) achieved a minimal response or better, including 50% with a partial response or better. Median progression-free survival was 10·8 months and median overall survival 30·6 months. Response was associated with phospho-Akt in pharmacodynamic studies. Perifosine-lenalidomide-dexamethasone was well tolerated and demonstrated encouraging clinical activity in relapsed and relapsed/refractory MM.

Closing Knowledge Gaps to Optimize Patient Outcomes and Advance Precision Medicine.

Realizing the promise of precision medicine requires patient engagement at the key decision points throughout the cancer journey. Previous research has shown that patients who make the "right" decisions, such as being treated at a high-volume academic medical center, for example, have better outcomes. An online survey was conducted to understand awareness of and barriers to these decision points among patients with multiple myeloma and pancreatic, lung, prostate, and metastatic breast cancers. Survey respondents were identified by 5 participating foundations (multiple myeloma: n = 86, pancreatic: n = 108, lung: n = 56, prostate: n = 50, metastatic breast: n = 86) and recruited by an e-mail or social media invitation. Descriptive analyses were calculated, and the proportion of patients from each of the 5 groups was compared for each response category for each survey item. Consistent gaps in knowledge and actions were identified across all cancers evaluated in terms of finding the right doctors/team at the right center; getting the right diagnostic testing done before beginning treatment; engaging in the right course of treatment, including clinical trials; and in sharing data. Improving awareness of and changing behavior around these 4 decision points will allow patients to receive better care and contribute to the advancement of precision medicine.

Company Profile: Multiple Myeloma Research Foundation.

The role of nonprofit organizations in drug development has evolved from a primary emphasis on grant funding to a driving force that is advancing scientific development and leading cutting edge research. The Multiple Myeloma Research Foundation (MMRF) is a leader in this field, and has recognized that despite recent advances, multiple myeloma patients' responses to today's treatments are variable and unpredictable, often based on the patient's molecular profile. The MMRF believes all patients would benefit from the creation of new, personalized treatment approaches and is working to make this vision a reality with its ambitious Personalized Medicine Initiative. Most recently, MMRF launched the CoMMpassSM (Relating Clinical Outcomes in Multiple Myeloma to Personal Assessment of Genetic Profile) study to collect and analyze tissue samples and genetic information from approximately 1000 multiple myeloma patients over the next 5 years. The study is designed to tailor next-generation personalized multiple myeloma treatments.

One foundation's strategy to accelerate drug discovery through genomics.

The Multiple Myeloma Research Foundation (MMRF) has the principal goal of accelerating development of next-generation drugs for treating multiple myeloma. By making targeted investments in key research areas such as genomics and epigenetics, the MMRF is helping to elucidate the basic biology of multiple myeloma, to drive promising new treatments into clinical development, and ultimately to link the right treatment to the right patient.