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Treating Multiple Myeloma With Other Cancer Drugs

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Published on January 14, 2020

Key Takeaways

    Drugs that are used to treat other cancers (like JAK inhibitor drugs for MPN patients and venetoclax [Venclexta] for CLL and lymphoma patients) are being looked at to treat myeloma.
  • Doctors are also looking to recombine other myeloma drugs in lower doses.
  • Chemo drugs, even though you don’t hear a lot about them, can also still be used in combination.

Multiple myeloma expert Dr. James Berenson, from the Institute for Myeloma and Bone Cancer Research, discusses research on repurposing certain drugs that have been effective for other cancers to treat myeloma, and re-combining current treatments to reduce toxicities. Watch as Dr. Berenson shares findings on therapies originally approved for myeloproliferative neoplasms (MPNs) and chronic lymphocytic leukemia (CLL) showing benefit for myeloma patients. 

This program is sponsored by Karyopharm. This organization has no editorial control. It is produced by Patient Power. Patient Power is solely responsible for the content.

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Transcript | Treating Multiple Myeloma With Other Cancer Drugs

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.

Esther Schorr:

Hi there.  This is Esther Schorr with Patient Power at ASH 2019 in Orlando, Florida.  I'm here with Dr. James Berenson who has a mouthful.  He is the President and Medical and Scientific Director of the Institute of Myeloma and Bone Cancer Research.  Welcome again.  

Dr. Berenson:

Thank you.  

Esther Schorr:

To one of our favorite people. 

Dr. Berenson:

Favorite regulars. 

Esther Schorr:

Regulars, no, it's great.  So what I wanted to talk to you about is what's going on here at ASH and the work that you're doing related to advanced cases of multiple myeloma.  What's new?  What's happening in that? 

Dr. Berenson:

Well, there are a lot of new drugs that are getting repurposed, and it's pretty exciting.  We're doing a lot of work now with the JAK inhibitors.  We find that a drug that has been used for myeloproliferative disorders, that is patients with myelofibrosis, polycythemia, or patients with essential thrombocythemia.  We're now finding that drug is I think going to have a place in myeloma.  It's pretty exciting. 

And those stories actually many times come out of clinics where patients may happen to have the disease that it's approved for, but then they happen to have myeloma, and then you put those treatments together, and voilà, something happens.  And so there's a lot of biology that is supporting that in regards to the impact of JAK inhibitors in myeloma bone marrow shutting done the proteins that actually prevent your immune system from working, up regulating types of cells that will drive immunity to work better and directly killing the tumor cell as well as getting rid of some of the resistance mechanisms that occur to other drugs such as lenalidomide (Revlimid).  So that's kind of an exciting area.  

In a similar vein, a drug, venetoclax (Venclexta), which is used widely to treat CLL and some lymphomas, it certainly had some play now in myeloma.  There was some concern of an increased death rate in a trial called the BELLINI among which patients either received that drug Venclexta with bortezomib (Velcade) and dex (Decadron) or Velcade and dex alone, but that may have been just kind of a quirkiness of the trial.  In addition the doses of Venclexta used were far higher than what we're now finding effective in clinic.  So, again, using lower doses of some of these drugs can be quite effective when used with myeloma drugs in patients that are heavily pretreated. 

And then we have of course the antibodies which are being combined with everything now, both elotuzumab (Empliciti) as well as Darzalex or daratumumab, and now we have a new kid on the block which should be approved in 2020 called isatuximab, which is like Darzalex, and that drug looks like it's going to probably move to the clinic as well with an approval soon. 

Esther Schorr:

For the benefit of patients, what I'm hearing from you is that there is now because of—is it genetics, the underlying genetics that some drugs that were originally for one disease now are maybe working for others?  Is that how that works? 

Dr. Berenson:

Yeah.  Sometimes this comes from the biology that we discover, but a lot of times it comes from just anecdotal treatment of individual patients who may have a disease that something's approved for and then they happen to have another disease that it's not, and it works for the other disease.  And then it leads to a lot of biology that can provide actually not only the basis for using it in myeloma but perhaps for many other cancers as well, which I think is very exciting, sort of spreading the love with these drugs and repurposing them, which we're doing a lot of. 

We're also seeing that these drugs can continue to benefit patients, that is, myeloma drugs, when recombined.  So the old dictum in treating cancer when I was training back in the early ‘80s was you get a drug once and you're done.  One and done.  It's not true anymore.  These drugs can be reused and reused in different combinations and be highly effective for long periods of time.  And one of the advantages you have when you combine drugs is you can sometimes tamp down the doses, reducing the toxicity.  So if one drug is nerve toxic, another one, say, is heart toxic, you bring both doses, you can effectively combine them, and you've made the patient happier because they not only have the effectiveness, but they're getting lower doses, putting themselves at less risk for having the side effects which can trouble patients at the higher doses. 

Esther Schorr:

And it sounds like you're also combining some earlier chemotherapy drugs with these other kinds of drugs, the immunotherapy drugs.  Is that right? 

Dr. Berenson:

Yes.  Yes.  I mean, we have certainly used the chemotherapy drugs, the alkylating agents such as cyclophosphamide (Cytoxan), melphalan (Alkeran) and bendamustine (Bendeka) as well as the anthracyclines like Doxil or doxorubicin in the past, but we're learning that you can combine these drugs with the newer agents, and they can be really effective. 

And a lot of times these patients never see these drugs anymore, because people are so glomped on to the new generation.  They forget about the old kids, which can be quite effective.  And many of these agents are oral, and as patients move along here they don't want to be coming to clinic every day.  They want to be able to have a life outside of coming to me. 

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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