Keynote lecture interview: María-Victoria Mateos Manteca
This year’s Opening Ceremony Keynote Lecture on ‘How the treatment is evolving in transplant-eligible newly diagnosed Multiple Myeloma?’ is being delivered by María-Victoria Mateos Manteca, Associate Professor of Haematology and Consultant Physician in the Haematology Department at the University of Salamanca, Spain, and Director of the Myeloma Unit, where she is responsible for coordinating the Clinical Trials Unit in Salamanca University Hospital’s Haematology Department.
Q: Welcome to this year’s EBMT Congress María-Victoria. Like all our delegates, I am sure you are very disappointed that we cannot meet in person this year. COVID-19 has impacted all of our work – can you tell us how badly your own hospital and city was affected?
A: COVID-19 has impacted all our lives, our work, the way in which we’ve been attending our patients…many changes because of a tiny virus. Salamanca has been seriously affected by COVID-19 because of its proximity to Madrid and its popularity with tourists. During the peak of the pandemic (March-April) the hospital was fully dedicated to COVID-19 patients and over 1500 patients have been admitted.
Our haematology unit was the unique “island” that was COVID-19 free in the hospital for the management of patients with haematological disorders. We established virtual medicine in order to minimise the visits to the hospital and set-up drug delivery at home. Since mid-May we have again restarted our hospital activity, including transplant and CAR-T. We are seeing new outbreaks of COVID-19 right now and hope they can be controlled until a vaccine is available.
Q: Tell us a little about your own career, which fields have you worked in and for how long have you been based at Salamanca?
A: I studied medicine at the University of Valladolid, Spain (1987-93) and completed my residency in haematology at the University Hospital of Salamanca. In 2000, I obtained my PhD (Methylation of the p16 gene in Multiple Myeloma). Currently, I work as Director of the Myeloma Program and coordinate all clinical trials developed in the haematology department. When I obtained my PhD, I started to be involved in the organisation the clinical trials unit as it is today. At the same time, many novel drugs emerged for multiple myeloma and I had the enormous privilege of being selected by Jesús San Miguel, my mentor, to collaborate with him in myeloma in both the care of patients as well as in clinical research. Some years later, I became involved with the Spanish Myeloma Group in the design and development of clinical trials in multiple myeloma. Some of these studies helped to change the treatment paradigm this disease.
Q: Could you tell us a little more about some of these important trials you have been involved in?
I have focused my clinical research in two topics: asymptomatic myeloma and newly diagnosed elderly myeloma patients. Concerning so-called ‘smouldering’ myeloma, the standard of care was no treatment, and we investigated first how to identify some patients with asymptomatic myeloma at high risk of progression to myeloma (50% at 2 years) and planned a phase 3 randomised trial with early intervention vs observation. The study results were positive, not only in delaying the progression to myeloma, but also prolonging overall survival. This benefit is sustained right now with more than 9 years of follow-up and established the basis for many clinical trials in this setting. We continued with a curative approach for these asymptomatic patients. The trial is ongoing, and results are encouraging but preliminary.
Concerning elderly patients with myeloma, 60 Spanish newly diagnosed myeloma patients received for the first time the combination based on bortezomib plus melphalan and prednisone (known as VMP) in 2004, and the results were confirmed in a phase 3 randomised trial. VMP has been one of the standard of care regimens for these patients. We worked into its optimisation moving to the weekly administration of bortezomib, alternating bortezomib with lenalidomide in another trial and finally we have been actively involved in the pivotal study that daratumumab was combined with VMP resulting in another standard of care. Finally, we moved to a clinical trial currently ongoing focused on fit elderly patients planning an intensive approach and response-adapted design. The primary objective is the minimal residual disease negativity rate, and we will see how it translates in outcomes.
Q: What are some of the latest developments in the field of multiple myeloma that you will cover in your talk?
A: I will give a general overview of the disease and its management focusing on the role of autologous stem cell transplantation, and how it will be challenged in the near future because of the introduction of multiple drug combinations together with tools able to evaluate the response in depth and to predict the patients’ outcomes. I will cover the role of immunotherapy in a challenging disease like multiple myeloma.
Q: What will change for multiple myeloma patients in their near future – are some of these drug combinations already being used?
A: The landscape of treatment for patients with myeloma is exciting because many new agents are emerging so the first change is longer overall survival, because patients can receive more and more lines of different therapies. Together with the classical proteasome inhibitors and immunomodullatory drugs (1st and 2nd generation), anti-CD38 monoclonal antibodies arrived and now we have BCMA-targeted therapy through conjugated mABs, bispecific mAbs or CAR-T cells. In addition, drugs with different modes of action are also available like venetoclax, melflufen or Selinexor. New targets are emerging and, in summary, all these new possibilities will prolong the overall survival of multiple myeloma patients. We are also hoping they can contribute to finding a cure for the disease.
Q: What are some of the other lectures and sessions on multiple myeloma that you might watch at this year’s special online congress?
A: EBMT is a transversal congress so it is possible to attend many different sessions and myeloma will be a big part of them. In a more specific way, there are 8 different sessions focused on myeloma, 17 presentations and 59 abstracts. I will attend some symposia organised by pharmaceutical companies or cooperative groups as well as the educational session that will cover the novel immunotherapies in myeloma. The oral session will be also very interesting with results of some studies incorporating the monoclonal antibodies as part of the first line of therapy but others with more than 10 years of follow-up and the information is useful for our daily clinical practice.
Q: What are the other fields you are interested in in this year’s congress?
A: Although the cellular therapy based on CAR or other modalities is a bit topical and everybody is interested in it, it is important to see how the programme will cover other relevant aspects around the transplant like early and late complications, minimal residual disease and immune reconstitution. I am personally interested in the latest advances in cell therapy in haematological diseases other than myeloma to learn and capture some aspects that could potentially be applicable to myeloma.
Thank you Maria-Victoria, and enjoy EBMT 2020!