Medical Oncologists have been steadily moving away from chemotherapy treatments for the last decade. With rare exceptions, new cancer treatments are aimed either at specific gene products promoting growth of cancers or at enabling the immune system to fight the cancer. Elotuzumab is an immunotherapy aimed at the CS1 molecule found on myeloma cells and "null killer" cells, or NK cells.
When elotuzumab binds to NK cells it activates them and when it binds to myeloma cells it identifies them for destruction by the immune system.
The first article on elotuzumab in our library at PCR Oncology is by A Jakubowiak et al in the Journal of Clinical Oncology Vol 30 No 16, June 1 2012. This is a Phase I study of elotuzumab in 28 patients with relapsed myeloma, who were treated with escalating doses of elotuzumab in combination with bortezomib (Velcade). About half of patients responded and side effects were tolerable.
The second article on elotuzumab in our library is by S Lonial et al in the New England Journal of Medicine, volume 373, No 7, August 13, 2015. This paper describes the treatment of 646 patients with relapsed myeloma, who were treated with lenalidomide and dexamethasone with or without elotuzumab. The response rate in the elotuzumab group was 79% (compared with 66% without elotuzumab). Side effects were mild enough that elotuzumab did not interfere with quality of life.
The FDA approved elotuzumab for treatment of recurrent myeloma in combination with dexamethasone and lenalidomide on 11/30/15.
We have now treated our first patient with this combination. While it is too early to judge his response to treatment, we can say he, like those treated in the studies above, has not experienced significant side effects.