Yesterday one of our very well informed readers, Steve, wrote this comment in response to my optimistic post:
With the MMRRF doing the GEP study over the next five years I think it’s very likely that the stage is being set for major advances in the concept of individualized treatments…treatments that will be specific to a patient on the molecular level. Still, that’s likely 10 years from now before that will bear pharmaceutical fruit.
I agree with Steve. But the “individualized treatments” he is referring to is only one of many possible directions that might bear “pharmaceutical fruit.”
I’m putting my money on immunotherapy.
At this year’s ASCO, it became clear to anyone covering the meetings that researchers have begun to make real progress with immunotherapies–moving from the theoretical to the practical.
The experimental myeloma drug, elotuzumab, is considered to be a type of immunotherapy. Elotuzumab is an antibody that “softens up” myeloma cells, making them more susceptible to attack by Revlimid or Velcade. But the new combo breast cancer wonder drug featured at ASCO in June, T-DM1, takes the process one step farther.
T-DM1 binds an extremely powerful cytoxic agent to an antibody similar to the one in elotuzumab. Once the antibody identifies a cancer cell, it latches on to that cell and the chemo is released directly into the cell, killing it instantly.
Here is a LINK to a story I did about T-DM1 last month.
While this process hasn’t been perfected for use against myeloma cells yet, researchers can use the idea and hopefully save years as they work to develop a similar plan of attack for our cancer.
And that’s my point. Research developments are available instantly for others to use, speeding everything up.
And while researchers fine tune this idea–and others work to individualize the treatment process–still other researchers can concentrate on another concept which should help us live longer: combination therapies.
Remember, it has only been three or four years since our docs started combining novel therapy agents to treat our multiple myeloma. Adding elotuzumab to the mix has already proven to overcome drug resistance in a significant number of relapsed/refractory patients.
But elotuzumab isn’t the end-all in myeloma related immunotherapy. It’s only the beginning!
Our dear friend, researcher Gary Blau at Purdue University, reminds me often that simply using the drugs and drug combos that are available to doctors now can increase their effectiveness by 20 or 30 %–and maybe more.
Gary, maybe you can jump-in and share your incredibly hopeful news about improving how well existing therapies work by better matching the dose and dosing schedule to a patient’s individual physiology.
So let’s summarize:
New myeloma chemotherapy agents in the research pipeline. CHECK.
Molecular level individualized therapy like Steve mentioned. CHECK.
A number of different immunotherapy possibilities. CHECK.
Global information sharing between researchers which should significantly speed-up therapy development time. CHECK.
New combination therapy approaches which are already helping to overcome myeloma’s resistance to therapy. CHECK.
Improving the effectiveness of existing therapies by matching the best dose and dosing schedule to an individual patient’s physiology. CHECK.
And this list doesn’t even include what I feel is one of the least studied major therapy options: the high dose mix used in stem cell transplants. Is melphalan alone really the best and only high dose chemo option for stem cell transplants? Really? My understanding is that University of Arkansas Medical Sciences (UAMS) uses a cocktail of several different drugs in their high dose chemo approach. My myeloma specialist admitted to me recently that most transplant centers only use melphalan because that’s what’s used in the largest research studies. In other words; because everyone else is using it.
And speaking of UAMS, Dr. Barlogue and his colleagues in Arkansas have been experimenting with aggressive anti-myeloma treatments–like “supercharged” Total Therapy for decades–resulting in an overall survival record that is consistently higher than the industry average.
WHEW! That’s a lot of ways to help us all live longer! And I’m sure some of you could add to my list…
When you look at all that is being done to help us battle our myeloma, how can you not be hopeful and excited?
I will concede that it is unlikely that any of these different strategies will result in a cure. But there is no question in my mind that many myeloma patients can and will live five or ten years longer than they do now as improvements continue to be made along all of these fronts.
Of course I cover all of this–along with specifics about the most promising new myeloma therapies–in my new book.
Writing New Multiple Myeloma Therapies from a Patient’s Perspective was a blessing for me. Who knew such a technical topic could leave me feeling so hopeful and alive?
As I prepared to send the transcript off to my publisher, for the first time in years I felt like I might be around for a while. And that’s pretty special!
Feel good and keep smiling! Pat