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Drugs Approved for Other Cancers Overcome Resistance in Myeloma

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Published on March 4, 2020

Key Takeaways

  • Experts are successfully repurposing drugs approved for myelofibrosis, chronic lymphocytic leukemia and other diseases to improve outcomes in multiple myeloma.
  • Ruxolitinib (Jakafi) and venetoclax (Venclexta), two drugs initially approved for other blood cancers, are bringing hope to myeloma patients.
  • If you have been diagnosed with multiple myeloma, consult a specialist for help.  

“We’ve repurposed this drug, and I think it will really lead to a lot of new treatments for myeloma that are not only effective, but really well-tolerated,” says Dr. James Berenson, explaining how experts are using ruxolitinib (Jakafi) and other drugs to overcome resistance in multiple myeloma. Watch now as Dr. Berenson, the Medical & Scientific Director at the Institute for Myeloma & Bone Cancer Research, shares promising news from clinical trials and explains why he and other experts are excited about the future for multiple myeloma patients.

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Transcript | Drugs Approved for Other Cancers Overcome Resistance in 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.

Andrew Schorr:         

Hello and welcome to Patient Power. I’m Andrew Schorr in Southern California near San Diego. Joining me is an old friend and a specialist in multiple myeloma, Dr. James Berenson, who’s up in Los Angeles and West Hollywood, California. Dr. Berenson, I have been treated over the years for myelofibrosis with a drug called ruxolitinib or Jakafi, and with any of these drugs that are active in cancer, you say, “Well, can it work for something else?” I’ve been hearing that maybe there’s some utility for Jakafi in myeloma.

Dr. Berenson:            

Well, I’m very excited to tell you that that’s what we found with just that drug, ruxolitinib or Jakafi. And we were lucky enough to have a patient who had both polycythemia rubra vera where it was being used and then developed myeloma. And after discontinuing the ruxolitinib fearing that the drugs we used for myeloma would lower his counts. And as we know, Jakafi or ruxolitinib could do that, we tried him on some myeloma treatments like bortezomib (Velcade), and at that time, Revlimid. This was even before we had pomalidomide (Pomalyst) or carfilzomib (Kyprolis). He failed both. And then we decided to put him back on the ruxolitinib and add it to Revlimid. And oh, my God, did he respond. And that was six years ago.

And that led to a slurry of different preclinical studies we did to figure out mechanisms that uncovered immunomodulatory effects unknown with this drug. Effects on the microenvironment, effects on specific genes and proteins that led to resistance to lenalidomide or Revlimid that in fact ruxolitinib or Jakafi could overcome. And oh, were we excited. And then we started a trial and we were excited to tell you that about half the patients, all of them resistant and really resistant to Revlimid, simply by adding ruxolitinib at low doses had great responses. 

So, we’re very excited. And that work is expanding a lot. We’re even now testing the drug as a single agent. And it’s very interesting. And I guess I can only say that right now. But we’re really expanding our use of the JAK inhibitor class in myeloma and combining it with about everything we can get our hands on, because, as we know, this is an extremely well-tolerated drug. In fact, we have patients who found the drug and want to stay on it, because they feel so great on it. And I think that’s pretty unusual in oncology. So, here we’ve repurposed this drug. And I think it will really lead to a lot of new treatments for myeloma that are not only effective, but really well tolerated. 

Now, in that regard, we’re also repurposing another drug in myeloma for myeloma patients that’s been approved for some other related cancers like lymphoma and CLL, or chronic lymphocytic leukemia, called Venclexta or venetoclax. We’re seeing really good activity of that drug in combinations with a lot of the different myeloma drugs. And we are excited to tell you that we published data on combining it with daratumumab or Darzalex with Velcade. We hope to be starting a trial with an anti-CD38, that combination in the next few months. 

And so, I think we can repurpose some of these drugs. We don’t have to be so myopic in our views of them that perhaps we can spread the love, if you will, to other diseases and make patients avail the opportunity of getting drugs that not only work, but they’re actually well-tolerated. And as some of us know, the approvals for Jakafi or ruxolitinib were generally around improvals in quality of life. But in this case, not only have we seen quality of life, but we’ve seen actual really good responses, including complete remissions. 

Andrew Schorr:         

Wow. This is so cool. And I think that’s important for patients to understand that—and I want to underscore a couple of points. First of all, there may have been a drug approved for a different blood cancer, in this case, myelofibrosis or CLL with venetoclax or Venclexta. And where it has utility used in combination in multiple myeloma. And as you mentioned with ruxolitinib or Jakafi, it also gives you a second shot where a myeloma drug was no longer working. And you combine it with the ruxolitinib and then it is.

Dr. Berenson:            

Right. Very exciting.

Andrew Schorr:         

Wow. Okay. Well, we’ll stay tuned as you do your research and your peers around the world. And I think for me, having been on ruxolitinib, and hearing that it’s benefiting other people with myeloma, that’s just terrific. And I wish you well with your research. And I think for patients, keep your eye on this. Bring up this discussion. Hopefully you’re seeing a specialist in multiple myeloma. And all of these options are considered used in combination bringing a drug in from another condition to see does it really give you a better response? Dr. James Berenson, thanks for being with us and thanks for all you do.

Dr. Berenson:            

Thank you.

Andrew Schorr:         

I’m Andrew Schorr. Remember, knowledge can be the best medicine of all.

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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