Since all myelomas are not the same, treatment should be personalized and targeted to the different biological subgroups, said the CANOVA trial’s invited discussant Faith E. Davies, MD, Professor of Medicine, NYU Grossman School of Medicine, New York. For this approach, she said, three things are needed: altered biology of the cancer, a diagnostic test for such, and specific therapy. With 20% of myeloma cases harboring t(11;14), the alteration is potentially present, and testing is available. What has been lacking is specific therapy, and venetoclax may answer that need, she said.

Faith E. Davies, MD

“Like everyone else, I was excited to hear the results of the CANOVA study. I was a little disappointed that while it showed numerically longer progression-free survival, the difference did not quite meet statistical significance,” Dr. Davies said. “What can be learned from the study?”

CANOVA showed that compared with pomalidomide/dexamethasone, the time to the next treatment or death was much longer and the response rate much higher with venetoclax/dexamethasone. “As a clinician, I consider this to be really important because these results are clinically meaningful, and the side-effect profile was acceptable,” Dr. Davies commented. “We know that more treatment options result in improved survival. For me, the question is not whether I will give pomalidomide or venetoclax—it’s how am I going to use venetoclax in patients with t(11;14)?”

Preliminary results from the study by Kaufman et al suggest venetoclax used in combination, as it was with carfilzomib/dexamethasone, may be especially promising. Venetoclax plus carfilzomib/dexamethasone achieved a doubling in median progression-free survival and led to high response rates in refractory patients. “The study showed that we can use a venetoclax combination, and patients really can benefit. I think this is a great study..., and moving forward, venetoclax should be a drug that fits into my armamentarium.” 

DISCLOSURE: Dr. Davies has received honoraria from Amgen, Celgene, Takeda, Bristol Myers Squibb, AbbVie, Janssen, Oncopeptides, GlaxoSmithKline, Sanofi, and Pfizer; has received institutional research funding from Janssen and Celgene; has received reimbursement for travel, accommodations, or other expenses from Bristol Myers Squibb, Celgene, Takeda, and Janssen; and has served as a consultant or advisor to Celgene, Takeda, Amgen, Oncopeptides, Bristol Myers Squibb, Janssen, Sanofi, GlaxoSmithKline, AbbVie, and Pfizer.