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Expert Perspective: Living Longer and Better With MPNs

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Published on June 1, 2016

MPN specialist Dr. Mark Heaney discusses his role at Columbia University Medical Center and his approach to patient care. As a clinical investigator, Dr. Heaney provides insight into new and exciting treatments in development such as new JAK inhibitors, telomerase and others. He stresses the importance of understanding the disease to allow patients to live longer and better.

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Transcript | Expert Perspective: Living Longer and Better With MPNs

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—where we travel around the country, and now we’re recording this in New York City. And I’m with a noted expert in the MPNs. That’s Dr. Mark Heaney from Columbia University Medical Centre. Welcome to Patient Power, Dr. Heaney.

Dr. Heaney:         

Well, thanks, Andrew. It’s great to be here.

Andrew Schorr:                  

Thank you. Dr. Heaney, explain your role as, if you will, a subspecialist at Columbia.

 

Dr. Heaney:         

So Columbia, as an academic medical center, we’re really fortunate that we have physicians who subspecialize in different areas of cancer. And these days in most academic medical centers, there’s even super-subspecialization. 

So my particular area of interest is in the myeloproliferative neoplasms, but I’m a hematologic oncologist. But at Columbia, we’re able to have someone who’s a chronic lymphocytic leukemia expert and an acute myeloid leukemia expert, and I’m the myeloproliferative neoplasm expert.

Andrew Schorr:                  

Okay. And so that means the patients you see, who probably come from far and wide, have ET, PV, MF myelofibrosis, and you’re also doing research in those areas.

Dr. Heaney:         

That’s right. So, yeah, we’re very fortunate now that we have some effective treatments for myelofibrosis, which historically has been the most difficult of the MPNs to treat. But those treatments, although they work well, don’t always work forever.

And so there’s still an unmet need for treatments for patients whose diseases no longer respond to the initial treatments. And there’s also a need for treatments for patients who may have side effects from those medicines and for one reason or another can’t tolerate those initial treatments.

Andrew Schorr:                  

And because you’re a researcher, it’s likely that there’ll be clinical trials looking for tomorrow’s medicine that are at your center, and you can discuss with your patients. 

Dr. Heaney:         

That’s right, yeah, and that’s one of the ways that we really work to provide options for our patients. And I think one of the most important things for patients is not to have just one choice but to have different options.

And those options may include treatments for when the initial treatment stops working. But they may also include treatments at the very beginning that provide a choice between taking what might be considered standard treatment and then trying something new. Sometimes that’s taking the standard treatment plus a new medicine. Sometimes that’s something that’s chemically similar to the original medicine. 

And so we have trials that include early-phase clinical trials with medicines that haven’t been in that many patients and also treatments that are much farther along in clinical development where we’re trying to learn whether a new medicine might be better than what might be considered standard treatment. 

Andrew Schorr:                  

Okay. So then choices come up, and fortunately this is a field that’s moving forward, more research than ever before. So when somebody comes to you with any of these three conditions now, how do you personalize care, if you will, with both standard options and clinical trials and have it be personalized for their situation? How does the discussion go? What’s going through your head?

Dr. Heaney:         

So usually the first part of the discussion is really an education, and I think patients who understand the disease feel like they have much more control over their lives. And that’s the most important thing. So usually the first thing I do is to have a discussion about what the disease is, what we know about the natural history. And then I try to frame it within the context of the individual patient. 

So what’s different about their disease compared to what might be considered more run-of-the-mill MPN, and then based on that, talk about what the pluses and minuses might be for different treatments and whether there is a rationale to consider treatment—because there are many patients who don’t necessarily need a drug treatment at the time they first come to see me—and when new drug treatment might be a possibility. 

Andrew Schorr:                  

And then they’re in a relationship with you probably for a long time. Happily, now for more conditions including myelofibrosis, this is a partnership, isn’t it?

Dr. Heaney:         

Yeah, it really is, and I think one of the great things about my job is I’ve seen patients now that I’ve taken care of for 20 years and watched their children graduate, heard about all the stories. And it’s one of the most rewarding things, because that’s really what my job is, to allow patients to grow old and to get the kinds of medical problems that older patients get.

Andrew Schorr:                  

Right. Now, it was sort of terrifying to some people when you and your peers around the world started recognizing MPNs as a cancer, because they had been seen as like a disorder. 

Dr. Heaney:         

Um-hm.

Andrew Schorr:                  

And the cancer word is very scary, and to many people that meant, will this shorten my life or shorten my life in short order, depending upon the severity of it? But you’ve been seeing a lot of progress. Is it your belief that many of these conditions and for more people can be chronic—we’d like to cure it—but that they can live, go on with their life for a long time? 

Dr. Heaney:         

Yeah. You know, I think that many of the diseases, like polycythemia vera and essential thrombocythemia and for some patients myelofibrosis, have been chronic diseases for a long time. And you’re right, the cancer label can be scary.

But a lot of us who’ve been studying these diseases really think that that’s a more precise way of describing it and a more precise way of understanding the biology of the disease. And I think that that precision has led to more clarity in the scientific research and also has led to the development of treatments that are more specific.

And you’re right, the goal, I think for right now, is to make this a disease that’s a chronic disease. But I think a lot of us haven’t really given up on the idea of having an ultimate cure.

Andrew Schorr:                  

Yeah, have C mean cure. And that’s my last question really, and that is you’re a researcher as well; what is your specific research interest? What are the questions you’re currently trying to answer that could give us better treatments?

Dr. Heaney:         

Yeah. So in the MPN arena, I’m primarily a clinical investigator. And so we’re bringing new drugs to try to add to the arsenal. And there are a number of new drugs that have particular promise. 

The drug that we have that’s really changed, I think, the lives of many patients with myelofibrosis and now polycythemia vera is ruxolitinib or Jakafi. 

There are now second-generation inhibitors of the same target of ruxolitinib that may have a side effect profile that’s better than ruxolitinib and may be able to work in some patients with ruxolitinib doesn’t.

There are also drugs that attack new targets. And one of the drugs I think is particularly interesting is a drug that attacks telomerase, and telomeres are that part of the chromosome that actually provide youth to the chromosome. And as we get older, our chromosomes get older and they get shorter. And eventually when the chromosomes become too short, the cells die. 

Cancer cells—and this is where understanding that the myeloproliferative neoplasms are in the big cancer family has become important—have co-opted that process and have found a way to lengthen their telomeres and have been able to become younger.

Andrew Schorr:                  

They’re hijacking the telomeres. 

Dr. Heaney:         

That’s right. And so there’s an agent that attacks telomerase and kind of restores order to those cells. And earlier-phase clinical trials have shown really substantial promise in the myeloproliferative neoplasms. And so now we’re in the process of trying to find out how well those medicines work and also learn a little bit more about some of the side effects that they might have.

Andrew Schorr:                  

Very cool. So it keeps pushing forward. So what people want to know, bottom line, is with these conditions, are you hopeful that more people can do better, fewer side effects, live longer?

Dr. Heaney:         

Yeah, this is a very exciting time for those of us taking care of MPNs. A decade ago, we really didn’t have that much, and it didn’t seem like there was very much interest in the field, and I think that that’s all changed.

And some of that has come with the knowledge that many patients have mutations in genes like the JAK protein that provide a natural target, and finding ways to target the JAK proteins has given us that first foothold in changing the lives of patients. And now we’re onto the next thing, and it’s a very exciting time. And I think patients with MPNs have every reason to be hopeful.

Andrew Schorr:                  

All right. Living with one of them, I am so thankful that you say that. So thank you, Dr. Mark Heaney from Columbia University Medical Center. 

And, of course, so much more on our website in the MPN section, PatientPower.info. We’re dedicated to bringing you the latest information. 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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