BCMA Biomarker Updates in Myeloma

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Andrew Schorr:

All right.  Now let's talk about another area of medicine, biomarkers, okay?  Biomarkers, often from a simple blood test treatment, a drop of blood, can it say how you are doing, are your medicines working, what's your specific situation?  So new biomarker you've been working on.   

Dr. Berenson:

Well, not as new these days, we've been working on it for about four or five years, but it may be new to some of you.  It's called BCMA, or B-cell maturation management.  It is a protein on the surface of the myeloma cell, and it turns out it's the target of many of company now that's doing a new therapy, whether it's T cells, whether it's antibodies, whether it's what's called bispecific T-cell engagers or BiTEs, all these companies are targeting BCMA.  

And what we've shown is that BCMA on the surface of the myeloma, it's shed in the blood.  And what goes in the blood you can obviously measure it.  And what we're were lucky enough to find out, number one, it turns over every day, so the conventional marker, the M protein, turns over every month.  So, if you will, with the M protein it's like you're looking at the life of a sun in the next galaxy so that by the time it gets to its really old life, where the new marker is like looking at the light of our sun. You get a much quicker read.  So we've now been able to show that change in clinical status is assessed way more rapidly with BCMA than your usual marker. 

The other nice thing about it, as you mentioned, it's a drop of blood.  It's literally four microliters. 

Andrew Schorr:

…like a diabetes fingerer stick.   

Dr. Berenson:

Yeah, it's like the tip of your pen amount, and it's totally stable at room temperature.  We also know that the baseline level, we showed that in a clinical trial, predicts whether you're going to respond or not and how long you'll respond.  So not only can we get a quick read, but we can tell you before you start whether you should go on that treatment.  That's huge.  

Now, we need to do a lot more work.  This is a small trial to confirm that finding, but it's very promising data from early studies.  And we are spreading this well beyond simply myeloma.  So CLL, that Andrew knows a lot about… 

Andrew Schorr:

I have it.   

Dr. Berenson:

…there is no really good blood protein biomarker.  Well, now there is.  We now know from studies we've done with NIH and we've presented some at the meetings, that indeed the same thing holds in CLL, very quick marker.  Within a day or two starting like for ibrutinib (Imbruvica) you can tell whether you're responding or not responding.  

We also know from these studies with the NIH that the time to progression, you can find it much earlier with this marker than you can from conventional markers or from clinical things that happen to patients with CLL.  

Andrew Schorr:

Okay.  So we're in the age of precision medicine, and I'll tell you they've been talking about it like crazy.  There are a million diagnostic companies here at this major convention, so the idea is how do you get what's right for you.  And then along the way, how do you know what's working or what additional medicines you need or what additional medicines can be taken away because you're responding? 

So it works all different ways, but it's about shining a light easily, maybe with just a simple drop of blood. So what is your specific situation now. Is that right?  

Dr. Berenson:

Yeah, let me make two other points with this that are exciting.  One is, and they allow us early on to give you less therapy because if you know within a few days whether something is working or not, you may say the heck with this, I'm going to start with less, because you can always have the third drug.  We're not treating patients with acute leukemia where if you miss it the first week that can be trouble.  Myeloma, thankfully, is a chronic disease, so waiting a week to find out you may say that less is more, more, better quality of life.  We don't know that yet.  We have to do a trial to prove that.  We hope to. 

Andrew Schorr:

We need to measure, but if you can measure with a blood test you know what's going on that day or yesterday. 

Dr. Berenson:

Right.  It's a very, very big deal.  You don't have to wait until you get sick from the myeloma to know what's going on.  

Andrew Schorr:

Amen.  All right.  

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.