Her doctor calls Vivian Klein, 84, the poster child for carfilzomib, an investigational drug for multiple myeloma, a cancer of the plasma cells with no known cure. Klein has been taking the drug for the past four months, and so far, it is saving her life without causing adverse reactions.
That is particularly remarkable since Klein also might be described as the poster child for side effects.
Nurse Patrah Mack greets Vivian Klein, flanked by Klein’s daughters Linda Fleiderman (left) and Sandy Dumont. (Photo by p.cunningham)
Diagnosed in 2009, the retired hairdresser from Pacific Palisades, Calif., tried three other chemotherapy drugs before turning to City of Hope for help. Some successfully attacked the disease, but they also attacked her body — producing debilitating side effects like painful blisters, burns and rashes, numbness in her legs, personality changes and a potentially deadly skin condition called Stevens-Johnson syndrome.
Carfilzomib is still awaiting approval from the U.S. Food and Drug Administration and patients can only get it through clinical trials. Klein is on the drug because of City of Hope’s membership in the Multiple Myeloma Research Consortium, composed of 16 of the world’s leading medical institutions.
The drug is part of a new generation of medications called proteasome inhibitors. They cause harmful proteins to build up within cancer cells, forcing cells to kill themselves.
Klein only knows that the medication keeps her going.
In City of Hope’s Phase I Unit, Klein recently geared up to get an infusion of her medication as her daughters, Sandy Dumont and Linda Fleiderman, kept the mood light-hearted. “OK, Vivy, it’s showtime,” Fleiderman said.
As the drug dripped into her bloodstream, Klein entertained with stories from her colorful past — from her hardscrabble beginnings as a working mom of three who washed clients’ hair in her kitchen sink to the days of building up her Beverly Hills clientele, whom she served until well into her 70s.
“She’s a self-made woman,” said Fleiderman. “We never wanted for anything.” Fleiderman’s husband, internist Marcos Fleiderman, M.D., initially discovered abnormalities in his mother-in-law’s blood during routine blood work, before Klein had any symptoms. Now Klein is under the care of Amrita Krishnan, M.D., director of the Multiple Myeloma Program.
Klein and her daughters recount some previous side effects, before carfilzomib, when her finger swelled up “like a balloon,” a rash lit up her face “like a beacon,” and she “couldn’t remember her name or finish a sentence.”
“With the other chemos, she couldn’t do anything,” recalled Linda Fleiderman. “She was in and out of the hospital.”
But their animated, irrepressible mother is back. She deals with weakness in her legs from previous chemotherapy, which makes negotiating stairs in her Pacific Palisades townhome difficult, but feels no pain.
“Now I do everything I did before,” Klein said. Besides enjoying time with Dumont, Fleiderman and her other daughter, Diane Covington — as well as her tiny dog, Honey Girl — she has resumed shopping, painting, playing cards, dining out with friends, cutting her daughters’ hair and listening to Louis Prima and Patsy Cline albums.
Klein likes the camaraderie among her clinic’s caring staff and her fellow patients, whether they are dealing with setbacks or basking in encouraging news.
“We’re so grateful to City of Hope for allowing her to be in the program,” Fleiderman said, “and for having the kind of outcome we’re having.”
Multiplying their power against multiple myeloma
The Multiple Myeloma Research Consortium recently doubled its annual grant to City of Hope, reflecting the institution’s thriving studies into the disease.
A group of 16 major medical institutions that work together to find answers to multiple myeloma, the consortium tries to get new drugs to multiple myeloma patients as fast as possible. It was created by survivor Kathy Giusti, founder of the Multiple Myeloma Research Foundation.
“She was frustrated with how slow industry and academics were in working together,” said Amrita Krishnan, M.D., director of the Multiple Myeloma Program at City of Hope.
City of Hope joined in 2006 and is the only affiliated center in Southern California. Of the many clinical trials under way at City of Hope at any given time, Krishnan said, “we generally have about three to four trials from the consortium open.”
Some promising drugs currently under study:
- The proteasome inhibitors carfilzomib (a study led by Chatchada Karanes, M.D.) and oral bortezomib, or Velcade (led by Myo Htut, M.D.)
- A combination that includes the immune booster lenalomide and bendamustine, a drug already used for some forms of lymphoma and leukemia (a study led by Krishnan)
- GSK2110183, a drug that disrupts some of cancer’s mechanisms (led by Michael Rosenzweig, M.D.)
Consortium members meet regularly to share information about potential new drugs. The consortium also established a tissue bank shared by researchers at participating institutions. By pooling their findings, the physicians push progress faster.
City of Hope’s multiple myeloma team members are determined to quickly open new trials and get patients to the right trials, which helped City of Hope get increased funding from the consortium, said Krishnan. And that ultimately benefits those who need help most.
“Our membership is of huge benefit to patients in their access to new drugs,” said Krishnan. “It provides us with better biomarkers and understanding of the disease, and enables us to be at the forefront with other multiple myeloma experts in helping decide the landscape of new therapies.”