As Mary Lamia, a clinical psychologist, says “Hope structures your life in anticipation of the future and influences how you feel in the present. There is no question that today there is great cause for hope in the treatment of Multiple Myeloma (MM). It is with this hope I am excited to be attending ASH 2018 to learn more about new treatments for the disease. These treatments include personalized therapies, genomics in targeted treatments, immunotherapy, and CAR T-cell therapy.
There have been a record number of drugs developed in the last 10 years for the treatment of MM. The life expectancy of patients with MM has increased significantly with a three- to four-fold increase in survival for patients to 10 years and beyond. Some patients have been on maintenance therapy for 16 plus years with Lenalidomide. Africans Americans are two to three times likelier to develop MM that the White population. They are generally diagnosed at a later stage of the disease for various reasons, and it has been reported that African Americans might also possess favorable genetics that may respond better to some drugs. Therefore, African Americans may have a better prognosis.
Immunotherapy has been developed as a new class of drugs which along with immunomodulatory imid drugs (IMiDs), protease inhibitors, selinexor and venetoclax have contributed to the dramatic increase in the survival of MM. Immunotherapy has also been highly effective in treating some solid tumors such as lung, kidney, bladder cancers, head and neck cancers, and some specific colon cancers. Previous standard treatments for these tumors have included surgery, chemotherapy and radiation. Immunotherapy has been effective in attacking and killing tumor cells that have previously evaded immune surveillance.
In 2015, President Jimmy Carter disclosed that his melanoma had metastasized to his liver and brain. Doctors included in his treatment Pembrolizumab, an anti-PD-1 checkpoint inhibitor. Soon after treatment, he was back building homes for Habitat for Humanity with his wife, Rosalynn. Before the advent of immunotherapy President Carter’s cancer would have likely not had the same outcome. This treatment is effective in 22 percent of patients with this dreaded cancer resulting in dramatic long-term disease-free survival. Dr. Jesús San Miguel, et al, reported that embrolizumab in combination with lenalidomide and dexamethasone was a promising treatment for relapsed refractory MM.
James Allison, PhD, chair of immunology at the University of Texas MD Anderson Cancer Center (along with Tasuku Honjo, M.D., PhD., of Kyoto University in Japan) won the 2018 Nobel Prize for Medicine for their research on harnessing the immune system’s ability to kill cancer cells. From this research came the first checkpoint inhibitor drug and eventually the drug for President Carter’s melanoma. This therapy works by blocking some proteins on cancer cells that suppress or evade the immune function. After treatment, T-cells are able to bind and attack cancer cells resulting in cancer cell death. Dr. Allison’s mother died of lymphoma when he was very young, and his uncle died of melanoma – which may have motivated him to continue his years of research. This is a dramatic reward for a life’s work motivated by a remarkable family history.
I anticipate good news to come in the further development of novel therapies in the combination of modalities resulting in improving outcomes for the future of MM treatment. Specifically, I am anxious to see if treating smoldering MM or even MGUS can result in a CURE for MM.