Published on February 7, 2019
On-site in San Diego at the 2018 American Society of Hematology (ASH) annual meeting, Patient Power founders Andrew and Esther Schorr were joined by a panel of multiple myeloma experts, including Dr. Gareth Morgan, Dr. Mohit Trikha and patient advocate Jack Aiello, to discuss the value of sophisticated tests for patients. How can myeloma patients benefit from a minimal residual disease (MRD) test? How do the results impact cancer care? Watch now to find out.
Transcript | Why Is MRD Testing Important for Myeloma Patients?
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This minimal residual disease testing—Gareth, let me ask you this. Gail said she was told by her multiple myeloma specialist that “I could not have MRD testing after an autologous stem cell transplant and two years on ixazomib (Ninlaro) maintenance, because my original bone marrow biopsy sample was inadequate. There’d be nothing to compare it to.”
So, it depends what test you use. So, if you don’t have a sample for sequencing, then it simply doesn’t work. But the flow cytometry approach is—which is similarly sensitive—a Black Swan Initiative function. You don’t need to compare it from the beginning. So, you would be eligible for a flow cytometry assessment of your MRD status.
So, I’ve heard of the “Black Swan” movie. What is the Black Swan Onitiative?
Jack, do you want to explain that?
Yeah. So, the Black Swan Research Initiative was founded by the International Myeloma Foundation.
And the whole idea behind it was to develop better ways of testing patients. And out of it came MRD, which by the way, you said minimal residual disease. I’m hearing measuring residual disease as well. And that actually might be a better way to do it. In any case, there are a couple of different methods, as Dr. Morgan has suggested, for testing MRD. One is flow cytometry. And the other is next-generation sequencing. And both are being used. The whole idea of getting these tests done at some point is to validate them as being surrogate markers for overall survival. For progression-free survival, which takes so long to get to and close a clinical trial.
f we knew that MRD negativity resulted and correlated with overall survival, we could look at those patients’ MRD negativity as opposed to waiting 10 years to determine the overall survival numbers. So, it becomes really important.
So, kind of one of the things I see—I sit there in the clinics. I see lots of patients. People travel from quite long distances. If you have the benefit of these tests, you don’t have to wait. What you do is you monitor people sequentially. As long as their levels are either stable, going down, or non-detectable, you’re comfortable. If you start to see them coming up, you can intervene long before the patient ever gets clinically destructive disease. And you use a different therapeutic paradigm about manipulating the MRD state.
Then you can change horses.
Yeah. And that is to put this in context. They have more treatments than ever before, broader combinations, maybe sequenced combinations, and then this immunotherapy we’re talking about, okay? And then the MRD testing to see how is it going, right? And so, I think it’s a really hopeful time, right? And I think maybe for people, you have more than ever before. We have people living longer than ever before. And you may have tests that can tell people, “How well are we doing?”
Not only how well are we doing, but what should we do next?
What should we do next?
There’s a trial that will open up probably next—Q1 or Q2 of next year that looks at patients that have gone through maintenance and been on MRD, been MRD-negative for two years.
After two years of maintenance, they’ll be randomized to either continue maintenance or stop maintenance. So, is there a timeframe for when MRD can be used to direct next therapies or stop therapies? If you’re MRD-positive, does that mean that you should change dosages or change treatments? And right now, that’s not so well understood and certainly not used in general to determine subsequent treatment. So, it becomes a really important way. Mo had a question.
Go for it.
If I could just add one other point to this that we are asking ourselves. It’s what drugs do not develop? Sometimes to stop development and not expose patients to ineffective medicines is, I think, just as important as developing effective.
So, we’re utilizing these MRD trials to really dig deeper and say, “Is there a benefit? And if there isn’t, what is the unmet medical need? What is the need that I’m trying to fulfill?” And that’s part of what we’ve now captured very early on in our discovery stages. And say, “Those are the medicines that we want to bring forward.”