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Are New Drug Options Changing Treatment Standards and Strategies for Myeloma?

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Published on December 19, 2018

With the addition of more options for therapy, how is the treatment landscape evolving for multiple myeloma? Is the standard of care changing? Patient Power founder Andrew Schorr is joined by noted myeloma expert Dr. Elisabet Manasanch, from The University of Texas MD Anderson Cancer Center, to discuss the impact of more sophisticated testing, deeper understanding of genetic subtypes and a broader range of treatments on myeloma care. Dr. Manasanch also goes into detail about research on detecting myeloma, identifying high-risk and low-risk disease and treatment strategy in frontline and relapse setting. Tune in to find out more.

This is a Patient Empowerment Network program produced by Patient Power in partnership with The University of Texas MD Anderson Cancer Center. We thank AbbVie, Inc., Celgene Corporation, and Sanofi for their support.

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Transcript | Are New Drug Options Changing Treatment Standards and Strategies for Myeloma?

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That's how you’ll get care that's most appropriate for you.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

So there's data saying that you can treat it, that people can do well when you treat smoldering myeloma. There's data saying that the responses also seem to be better when you treat it in the smoldering stage than when you treat it once it's newly diagnosed myeloma.  There's data with some agents in terms of that it takes longer for the myeloma to progress, so from the smoldering to multiple myeloma takes longer if you treat it, but there are not a lot of studies with overall survival large studies.  

And so some of the—some physicians really want to see that data first.  So it it's really right now still if you have smoldering myeloma the standard is to not treat, to just watch it, but this may change in the next few years, maybe even the next couple of years.  

But I think that what is going to hopefully make—give someone advantages it's going to be actually in immunotherapy, so all the cell therapies using your T cells maybe with again other oral therapies, infusing your immune system, I think that that might be better.  But to be honest with you right now, in the clinic we still use the same therapies that we would use for regular myeloma, and only everything that we do is we continue the same treatments.  We just continue them for a longer time.  And then we also encourage transplant.  But there is not a different therapy right now for this type of patients.   

And so when we talk about a transplant we're talking about giving a very toxic chemotherapy drug that is called melphalan (Alkeran).  And so the transplant is just really giving you a chemotherapy drug.  So people that do the transplant, the difference is instead of getting the three drugs that usually most people get, they get the three drugs, and then they get the melphalan.  And so it's really just for us to be able to tolerate this really high dose of toxic medication called melphalan we need to get our stem cells collected first and then we have to put them back after the melphalan.  Otherwise, it would take forever for us to recover our platelets and white cells and everything, because the melphalan kills everything in the bone marrow, both the good cells and the bad cells.  But it's just another therapy.  

So this is why most patients will have melphalan, because it's just another therapy, and we're not curing most myelomas right now.  So people with start with one therapy and then go on.  One of the reasons why we still do a lot of transplants at MD Anderson with high-dose melphalan and why we give high?dose melphalan in the initial diagnosis is, because there are studies suggesting that when you give it in the very beginning the time of remission is longer.  And so we usually try to get the first remission, which is the remission you get right after initial treatment, to get the best remission we can get so to get rid as much of the myeloma as possible and then to have it last as long as possible.  And that maybe correlates with having better outcome, so many living more time without myeloma and maybe living more time.  And that's why we do it.  

And we do also a lot of—we do for these patients that don't want to do the transplant at diagnosis we do freeze and cryopreserve stem cells for later.  But all the transplant is is really just another treatment.  So the same as one gets diagnosed and you say, okay, I'm never going to take this drug.  Most people don't say that.  It's just another drug that we do for myeloma, but we still do it mainly because of the data with the remission, that's it's a longer remission.  That's mostly why we do it at MD Anderson.   

Dr. Manasanch:

I think that that's a good approach.  I do think that there's probably a subset of patients that will—they will just—initial treatment of a small subset of patients that will just need initial treatment, and they may not need any more treatment after that.  That's a very small minority.  But I also feel that as we progress I feel that there are more and more patients like that.  So I think that when people are newly diagnosed the hope will be that you're just going to do your maintenance and stay on your maintenance forever.  That would be the ideal, that's the hope.  

But, yes, if the myeloma comes back, we have very good therapies for second- and even third-line treatment.  So yes, definitely wait for the next best thing.  There are a lot of new therapies coming out.  There's probably going to be some new medications approved also this coming year by a FDA.  So there are so many new medications that it really is where you are in your treatment and what are the new drugs coming out.  

For example, when daratumumab came out it helped a lot of people.  With the CAR-T cells, in the studies are helping a lot of people now that didn't have a lot of options for treatment.  So, yes, there are going to be new generation of CAR?T cells coming out as well.  There are new medications, so definitely, yes.  Try to do the best that you can until the next thing, definitely.  

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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