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What Is the State of Precision Medicine for Myeloma?

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Published on March 15, 2018

What precision medicine targets are doctors testing for today in myeloma patients? Do these genetic targets have a compatible therapy? Noted experts, Dr. Mike Thompson and Dr. Mohit Trikha, joined us at the American Society of Hematology (ASH) 2017 annual meeting to discuss the current state of research on precision medicine for myeloma. Watch now to find out more.

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Transcript | What Is the State of Precision Medicine 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:

We should note that Cindy is “Myeloma Teacher” on the Internet—on Twitter and also on Facebook—so you correspond with thousands of patients. Someone else who corresponds with thousands of people is Dr. Thompson. I’m going to call him Dr. Twitter. He’s really a leader in social media, but Mike, you’re also a myeloma specialist. Any other headline you want to say about myeloma?

Dr. Thompson:  

We’ve had an explosion in therapies for myeloma, and I think maybe in the last year, there’s a little bit of a lull, but there are so many targets now, it’s just mind-blowing. And then, precision medicine—there were things that I knew about from other diseases, but not myeloma.

So, NRAS is something we check for in colon cancer but not in myeloma, and one of the sessions early today was talking about targeting NRAS mutations with MEK. We have MEK inhibitors we’re using in melanoma—another m-oma—but BRAF inhibitors work in myeloma. We have t(11;14) as about 25 percent of patients. 

So, we’re starting to get this panel of molecular aberrations to target, and multiple myeloma is one of the diseases that is in the NCI match—so, a big NCI study—but very few people have gone on trials for that.

So, I think we could potentiall yhave NCI match, too. They’re thinking about doing it with liquid biopsies and targeting myeloma, but instead of categories like “standard” and “high-risk,” it’ll be t(11;14) or BRAF-positive, and what we’ve found in some diseases like melanoma is 50 percent of people have the mutation and about 80 percent response rate, but that doesn’t work in colon cancer. You need to do two targets. So I think it’s still early going for precision medicine in myeloma, but it’s very exciting.

Esther Schorr:   

But my question is—and, you work in a community setting—it sounds like all of this research is going to be based on having a pool of patients who’ve been tested for these abnormalities. So, what’s the state of getting people tested?

Dr. Thompson:  

Right now, we don’t test for precision medicine targets like we do for other diseases. So, in lung cancer, we used to check for EGFR, and then we started checking for EGFR, ELK, ROS1 and now, BRAF is approved for lung cancer, so we check for that. We check for PD-L1. The list is getting to be pretty high for that, so now, we’re checking multiple things, but it gets to a point where instead of checking five things, maybe you check 500.

There might be some up-front cost, but if you can save it with expensive therapies you’re not giving and you’re giving the right things—I think we’re going to see that transition. There’s some resistance because there’s up-front cost, and it’s unproven, but I think either it’ll have to be on a clinical trial or we’re going to see how we can do it because a lot of insurance companies are balking at that cost. So it’ll be a part of implementation science as much as science.

Andrew Schorr:

One of the announcements that’s come out in sync with this ASH meeting is there’s a company called Foundation Medicine that does a lot of this genomic testing, and they’ve gotten some approval from the FDA now. What will happen—and Mo, maybe you’re aware of this – is as you invent drugs, there will be companion diagnostics to see if you have the target for this medicine. Am I right? That’s going on more and more. 

Dr. Trikha:           

Absolutely. What I was thinking…it wasn’t too long ago that in multiple myeloma, we didn’t know how to treat our patients. There was no really good therapy. In 2017, we talk about what are the right combinations, and how are you going to be logical about which combinations to use and what medicines to use? You want to create optionality for patients.

Also, we have to think about—to your point about Foundation Medicine—it’s personalized—it’s precision medicine. We want to have a companion diagnostic, but at the end, when we think about—at AbbVie and in oncology—early development and research, it really is an individualized medicine. One patient develops cancer. That is their life. It has an impact. 

How are we going to develop medicines that are actually going to help that one person? How do I know that that is the right combination that should be used, and how do I then think about which patient will not respond to my medicine or a combination? I think that’s where our field is going.

Andrew Schorr:

So, let me ask you this one, then, Mo. Many people wonder whether folks at a drug company are just knocking off drugs, or is there a lot of trial and error?

In other words, I get the sense you’ve been a scientist for years, and you’ve seen a lot of failures. This is not easy stuff in oncology, is it? 

Dr. Trikha             

It really isn’t, to be quite honest. When I think about cancer, I think about a normal cell that’s really breaking all rules. In life, we have to live by certain ground rules, but you’ve got a renegade, and if I try to develop a medicine that attacks, say, programmed cell death—normal cell refuses to die, and sometimes that’s the idea—the cancer cell just figures out an alternative pathway. Sometimes, I wish we hadn’t called it cancer. Cancer is not one disease; it is many diseases that are through genetic pathways. One myeloma could be quite different from another 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.