December 25, 2015 | by Letisia Marquez
If the past few months are any indication, the year ahead will be a better one for patients with multiple myeloma.
In November, the U.S. Food and Drug Administration (FDA) approved use of the first antibody for the treatment of the disease. The approval of that therapy, Darzalex (daratumumab), was followed two weeks later by the approval of another antibody: Empliciti (elotuzumab).
That’s great news to Amrita Y. Krishnan, M.D., director of the Multiple Myeloma Program at City of Hope. She sees firsthand the need for more treatment options for myeloma. The disease is a cancer likely to return even after a patient has been in remission.
The new approvals are just a hint of the progress expected in 2016. Here, Krishnan answers five questions about myeloma treatment and research advances to expect in the coming year.
1) What treatment advances do you expect for multiple myeloma in 2016?
There is a lot happening with CAR-T cell therapy. One study presented at the recent American Society of Hematology conference targeted the B-cell maturation antigen (BCMA) protein in myeloma cells. One patient achieved complete remission, so it’s a very exciting development.
NOTE: In T cell therapy, immune cells are collected from the patient’s own blood and genetically engineered to seek out and attack cancerous cells. These engineered cells are then multiplied in a laboratory and reinfused into a patient. CARs are chimeric antigen receptors, or proteins that allow the T cells to recognize a specific protein on tumor cells, which then leads the immune cells to attack the cancerous cells.
New antibody combinations are also showing a lot of promise. Daratumumab – the first monoclonal antibody approved for multiple myeloma treatment – binds to the CD38 protein on myeloma cells. The drug kills myeloma cells through multiple pathways, including using the body’s own immune cells. Elotuzumab was another antibody approved in December for treatment of multiple myeloma. This antibody binds to a different target – CS1 – which is also expressed on myeloma cells. Elotuzumab works in combination with Revlimid (lenalidomide), a drug that stimulates the immune system.
City of Hope has clinical trials using both of these antibodies, as well as T cell therapy, for multiple myeloma treatment.
2) How significant are those advances for the overall field?
Patients who have not responded to other treatments are having more success with immunotherapies and that is truly remarkable. We now have the potential to study these therapies in other novel combinations that could improve the survival rate, as well as long-term remissions, for multiple myeloma patients.
3) How will this improve the patient experience or patient outcomes?
We’ve already seen that immunotherapy will lengthen remissions. There is also work underway to make minimal residual disease testing more effective. This testing provides us with the ability to detect minute amounts of residual myeloma in the body, far below the level that we see under a microscope with a bone marrow biopsy.
We think patients with myeloma relapse because cancerous cells are left behind. So now that we have more effective therapies, we can use them to try to completely eradicate myeloma cells, which will reduce relapse rates.
4) What research progress do you expect in 2016?
There will be further improvement in survival rates, as well as a more thorough understanding of the biology of the disease and how to better treat relapsed myeloma, or myeloma that was in remission but has returned.
5) Overall, where is the field of cancer treatment and research moving in your myeloma?
It’s moving toward new combinations of therapies that are more effective in fighting cancer. One key combination is the use of immunotherapy drugs with chemotherapy, which is in the early stages of research but is already showing a lot of potential.
If you are looking for a second opinion or consultation about your treatment, request an appointment online or contact us at 800-826-HOPE. Please visit Making Your First Appointment for more information.