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How Close Are We to a Cure for Myeloma?

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Published on March 2, 2016

Can we start using the word “cure” in the conversation about multiple myeloma (MM)? In this roundtable discussion, Dr. Noopur Raje, Dr. Faith Davies and Dr. John Burke along with patient advocate Jack Aiello discuss clinical progress including new medications, combination therapy, monoclonal antibodies and genotyping that are increasing patient longevity and quality of life.  Listen as Dr. Raje discusses the 80 percent of patients that can achieve deep remission.

Clinical Trials Mentioned in This Video
Immunotherapy Clinical Trials
Monoclonal Antibody Clinical Trials
Adoptive Cellular Therapy Clinical Trials

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Transcript | How Close Are We to a Cure 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.       

Jack Aiello:       

So I'm a big baseball fan.  And at this meeting, I heard the word “cure” more than I've ever heard before.  There was actually a session titled “Myeloma: Path Towards a Cure.”  And a baseball game goes nine innings.  And patients want to know kind of what inning are we in with respect to curing some subset of myeloma patients.  So that’s my question to you all: how close are we?  What inning are we in towards getting towards a cure?  And I'll start with you, Dr. Burke.

Dr. Burke:            

I guess I would say the third inning.  The reason I say that is first of all, we already cure, I think, a small subset of myeloma patients.  Or at least there’s a small subset of myeloma patients who goes a long time and doesn’t seem to have a relapse.  But it’s all too small of a subset.  Where are we?  It’s hard not to be excited and bullish about a disease when you have three new drug approvals that are improving outcome within a month.  I can’t recall in my 12- or 13-year career as an oncologist ever seeing that in any disease, any cancer at all.

So clearly, big progress is being made right now.  It’s a little bit—also probably easy to be a little bit overexcited, as well, and to say that boy, we’re about to cure all myeloma, and we’ve made that mistake in oncology before, as well.  And so I think we don’t know whether adding checkpoint inhibitors or this or that new treatment is really going to lead to a cure, and I think, in general, progress in the field of cancer is incremental.  We hit singles more than we hit home runs, to use your baseball analogy.  And right now, I think we’re hitting singles, but we’re scoring some runs.  But we haven’t hit the grand slam yet, though.

Jack Aiello:         

Dr. Davies, you may be more of a soccer fan than a baseball fan.  So if you’d like to use a 90-minute analogy and what minute are we in of a soccer match, that’s fine. 

Dr. Davies:            

I was going to say I'm learning here.  As you know, I've recently moved to Arkansas, so I can talk about American football and Razorbacks, but my baseball knowledge is limited.  I agree.  I think we are currently managing to cure a percentage of patients by using combination therapies and by using them up front in newly diagnosed patients.  And there was some data today and yesterday discussing how that is potentially important.  Because as a myeloma patient’s disease relapses, then we find lots of different and unusual genetic abnormalities, and the actual myeloma gets more complex and, therefore, more difficult to treat.

And so by using all of these new drugs in an intelligent way at the beginning is going to be very important.  But as Dr. Burke said, we know that there’s about 15 to 20 percent of patients who unfortunately still do very badly even with our new treatments.  And there [have] been lots of discussions at the ASH meeting about how we can specifically try and concentrate on these patients, and how we can use all the new information we’ve learned from our genetic testing and our MRD testing.  But also these new drugs and how we can use them intelligently and put them together to try and make a big difference for those patients.

Jack Aiello:         

Do you think some patients will be treated earlier, and might that help?

Dr. Davies:            

I think so.  I think some of the data we’ve seen actually suggests the earlier you can get in there, and the quicker you can turn things off means that you can hopefully stop some of the complexity that creates later.  And many of these new drugs we’ve been hearing about have, hopefully, less or different side effects.  But also because they work in a different way, we’ve been talking about the immune system and harnessing the immune system; it may be that we can utilize some of that to really make a difference. 

Jack Aiello:         

Dr. Raje?

Dr. Raje:                

So I'm actually very excited, and I think excited because we now have the tools.  We have the drugs which we can put together, and we have the diagnostics to go with that.  The fact that we have MRD which we can look at—MRDs looking at disease at the minimal residual state with genotyping, which will allow us to see how deep you can get in terms of responses I think is incredible; the fact that we can combine some of these drugs because they’re safe.  And the way I think about is it that we certainly want to focus on the 15 and 20 percent of patients, which Dr. Davies is talking about, because these are the high-risk multiple myeloma patients where we need to do something different.

But what about the 80 percent where we do have a good chance of getting them into a very deep remission?  And those are the ones I'm going to start thinking about curing right away.  And the good news is we have a platform where we can think about curative options.  So that this ASH meeting has already told us, even in the up-front setting you should be using combinations.  If you piggyback that up with the monoclonal antibody, you’re probably going to get an even deeper response.  So we can truly, truly start thinking about curing subsets of these patients.  And then what we haven’t talked about at all is immuno-oncology in a slightly different way.  And that is cellular immuno-oncology, and that’s going to be a late-breaker tomorrow, Jack, so I'm not gonna give away too much of that. 

But you know, this is a way of thinking about very personalized care for your myeloma patients.  So that using things like training your T cells to work against your own myeloma, so CAR-T cells data will be presented.  And we are at a threshold where we’re going to be using things like that.  So incorporating all of this in the care of the myeloma patient, I do think the future is bright. And the hope is yes, we’re going to cure a bigger majority; not just the 20 percent we’re talking about. 

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.