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Time until a cure for myeloma
We have made much progress in myeloma, and there is still much left to be done. With so much funding and research going into myeloma, what is a realistic and approximate timeframe until a cure for myeloma will be found?
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Anonymous
Re: Time until a cure for myeloma
That is the $64,000 question, Anonymous. I personally hope it happens soon in a similar fashion to what happened in a related blood cancer, CML (chronic myelogenous leukemia). In the latter blood cancer, a remarkable medication was created called Gleevec which basically transformed CML from an incurable cancer to a chronic disease where people can live close to normal lives. I just read about the history of Gleevec recently and it was fascinating. Hopefully, myeloma's version of Gleevec is in the works somewhere.
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terryl1 - Name: Terry
- Who do you know with myeloma?: self
- When were you/they diagnosed?: August 10, 2011
- Age at diagnosis: 49
Re: Time until a cure for myeloma
Terry: Do you have the link to the Gleevec story you referred to? Or is that a book? Thanks.
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Ben S.
Re: Time until a cure for myeloma
My entire 64 years I've heard promises of a cure for cancer. During that time I've seen a tremendous increase in the occurence of cancer. Healthcare seems to have transitioned from a "do no harm" mindset to "don't do anything that can't be treated [at much higher revenue]]". We have a plethora of treatments for multiple myeloma but I don't see any incentive toward a cure. Healthcare costs would be reduced if we incented cures rather than treatments.
Re: Time until a cure for myeloma
While optimism is essential is the fight against multiple myeloma, the genetics and biology underlying the Gleevec story appears unique. This is because CML is associated with a genetic distortion of ONE specific protein -- called c-Abl - - and Gleevec inhibits cancerous activity of THAT mutated protein.
If a similar molecule determinant can be found in multiple myeloma, that would be great. But for now, multiple myeloma appears to be multi-factorial with no unique molecular target that is a cure-all. Which sucks.
If a similar molecule determinant can be found in multiple myeloma, that would be great. But for now, multiple myeloma appears to be multi-factorial with no unique molecular target that is a cure-all. Which sucks.
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Harry S TrueMan
Re: Time until a cure for myeloma
I have been in complete remission for over 6 years after two SCTs. Am I foolish to think that the disease will not reappear? Or, even after this long in remission, should I still be waiting for the "other shoe" to drop? And if it does reappear, should I assume it will be tougher to again achieve complete remission for another extended period of time?
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lyndaclark - Who do you know with myeloma?: Self
- When were you/they diagnosed?: August 2005
- Age at diagnosis: 49
Re: Time until a cure for myeloma
Just to poke my nose into this conversation.
When I see a comment regarding "no incentive for cure." I am concerned about the context in which this is made. I am making the assumption that this is a cynical comment geared towards the pharmaceutical industry and its for profit nature and the apparently rediculous price of medications and health care costs. And not towards all of the patients, caregivers, and clinical staff who work everyday to help push myeloma therapy forward to the day where maybe we can speak about cure and not just control.
First, there are cures in cancer.
Second, for certain diseases there may not be or at least there are no curative treatments to date. Myeloma is one of those diseases. However, all the work (and dollars) that patients on clinical trials, clinical investigators, nurses, translational researchers, basic researchers, federal grant funding, private foundation funding (e.g. MMRF, L&L Society) and yes pharma have put into developing therapies for myeloma have at least doubled survival for most patients over the past decade.
10 years ago the median overall survival of a myeloma patient was 2-3 years. Today we have moved that to at least 6-7 and predictably longer. This may not translate directly towards cure, but it does translate to increased quantity and hopefully quality of life. Therapy is not perfect for everyone. And part of what we strive for in myeloma is to make it as chronic a disease as possible. But I would be willing to state that most individuals who have and treat myeloma would like to find a way to cure the disease.
Third, myeloma remains a disease where relapse is inevitable. This is due to the biology of myeloma not a lack of incentive. The biology of myeloma is incredible complex. It's just not quite as simple as the BCR-Abl CML story (not that CML is that simple either -- ask those who are resistant to Gleevec and the other TKIs). Therefore, we have not yet been able to define a mechanism to control myeloma with one pill like has been done with CML (Gleevec). But I would argue that today myeloma is moving to a point where the medications and therapeutic strategies have lead to improvements in care, making this disease a chronic disease for a large number of myeloma patients -- a number that continues to grow.
Fourth, I agree, if we could cure myeloma, health care costs would be significantly reduced.
Cure is always a hope and goal. However, the reality is today we are not there and therefore will continue to offer our patients all that we can. Again, we have a long way to go.
When I see a comment regarding "no incentive for cure." I am concerned about the context in which this is made. I am making the assumption that this is a cynical comment geared towards the pharmaceutical industry and its for profit nature and the apparently rediculous price of medications and health care costs. And not towards all of the patients, caregivers, and clinical staff who work everyday to help push myeloma therapy forward to the day where maybe we can speak about cure and not just control.
First, there are cures in cancer.
Second, for certain diseases there may not be or at least there are no curative treatments to date. Myeloma is one of those diseases. However, all the work (and dollars) that patients on clinical trials, clinical investigators, nurses, translational researchers, basic researchers, federal grant funding, private foundation funding (e.g. MMRF, L&L Society) and yes pharma have put into developing therapies for myeloma have at least doubled survival for most patients over the past decade.
10 years ago the median overall survival of a myeloma patient was 2-3 years. Today we have moved that to at least 6-7 and predictably longer. This may not translate directly towards cure, but it does translate to increased quantity and hopefully quality of life. Therapy is not perfect for everyone. And part of what we strive for in myeloma is to make it as chronic a disease as possible. But I would be willing to state that most individuals who have and treat myeloma would like to find a way to cure the disease.
Third, myeloma remains a disease where relapse is inevitable. This is due to the biology of myeloma not a lack of incentive. The biology of myeloma is incredible complex. It's just not quite as simple as the BCR-Abl CML story (not that CML is that simple either -- ask those who are resistant to Gleevec and the other TKIs). Therefore, we have not yet been able to define a mechanism to control myeloma with one pill like has been done with CML (Gleevec). But I would argue that today myeloma is moving to a point where the medications and therapeutic strategies have lead to improvements in care, making this disease a chronic disease for a large number of myeloma patients -- a number that continues to grow.
Fourth, I agree, if we could cure myeloma, health care costs would be significantly reduced.
Cure is always a hope and goal. However, the reality is today we are not there and therefore will continue to offer our patients all that we can. Again, we have a long way to go.
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Dr. Ken Shain - Name: Ken Shain, M.D., Ph.D.
Beacon Medical Advisor
Re: Time until a cure for myeloma
Lyndaclark,
There's a decent chance that you may be fortunate enough to have achieved what will become a very long remission from myeloma.
Perhaps Mark, who often posts here, can help out a bit more, since he seems to track these things pretty well. But I believe that, if you look at the survival curves for many myeloma treatment regimens, there often is a group of patients that, after a while, just keeps surviving and surviving and surviving.
In technical terms, what you see is the survival curve flattening out.
You may be one of those fortunate long-term survivors!
There's a decent chance that you may be fortunate enough to have achieved what will become a very long remission from myeloma.
Perhaps Mark, who often posts here, can help out a bit more, since he seems to track these things pretty well. But I believe that, if you look at the survival curves for many myeloma treatment regimens, there often is a group of patients that, after a while, just keeps surviving and surviving and surviving.
In technical terms, what you see is the survival curve flattening out.
You may be one of those fortunate long-term survivors!
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JimNY
Re: Time until a cure for myeloma
My opinion on the issue of cure in myeloma is that it is as much a testing issue as it is a therapy issue. I believe that everyone agrees that myeloma is curable in the context of allogeneic transplantation done early in disease course. Many myeloma patients are not eligible for the procedure due to age, insurance issues, etc. IMO myeloma is a potentially curable disease for younger patients. There is no test to determine with certainty that an individual is cured, but it seems fairly standard across all blood cancers that relapse is uncommon after a patient is in remission for 5 years after an allo.
For example, one of the statistics I have cited previously is worth noting. This comes from a 2003 study, so these are patients treated with allo in the 1990's.
"Of these 48 patients, 16 (33%) attained durable PCR-negativity after transplantation, whereas 13 (27%) remained persistently PCR-positive and 19 (40%) showed a mixed pattern. The cumulative risk of relapse at 5 years was 0% for PCR-negative patients, 33% for PCR-mixed patients, and 100% for PCR-positive patients. Within the group studied it was not possible to identify any clinical feature predictive of durable PCR-negativity."
However:
"The attainment of persistent PCR-negativity has a favorable impact, but it is not synonymous of cure, since we observed a patient relapsing after 9 years of molecular remission (Figure 1B). The escape from the immunologic control of a residual myeloma clone can perhaps explain the occurrence of very late relapses."
http://bloodjournal.hematologylibrary.org/content/102/5/1927.long
Since only 1 out of 16 patients that had a sustained molecular response relapsed in 9 years, IMO a sustained molecular response after allo should be considered a functional cure. I do agree that a patient cannot "pop a pill" and be functionally cured. I think the patients are asking for too much to think a drug could cure a blood cancer like myeloma. Potentially a vaccine type of approach could be found. It likely would have to be given to a patient in first remission to be effective. Unfortunately, the concept of a myeloma vaccine has been around for a long time and none have proven effective. IMO it takes some type of effective immunotherapy to cure myeloma.
I for one would like to thank all the doctors that have worked hard and made allo transplants a much safer and efficient procedure. I do not go to Moffitt, but I know they have put out some great research on allo transplants and very likely have functionally cured some patients. Since allo transplant is a potential cure and great strides have been made in the last decade in allo transplantation, IMO we are making great progress toward a cure in myeloma for the younger patients. Keep up the great work Dr. Shain!
Mark
For example, one of the statistics I have cited previously is worth noting. This comes from a 2003 study, so these are patients treated with allo in the 1990's.
"Of these 48 patients, 16 (33%) attained durable PCR-negativity after transplantation, whereas 13 (27%) remained persistently PCR-positive and 19 (40%) showed a mixed pattern. The cumulative risk of relapse at 5 years was 0% for PCR-negative patients, 33% for PCR-mixed patients, and 100% for PCR-positive patients. Within the group studied it was not possible to identify any clinical feature predictive of durable PCR-negativity."
However:
"The attainment of persistent PCR-negativity has a favorable impact, but it is not synonymous of cure, since we observed a patient relapsing after 9 years of molecular remission (Figure 1B). The escape from the immunologic control of a residual myeloma clone can perhaps explain the occurrence of very late relapses."
http://bloodjournal.hematologylibrary.org/content/102/5/1927.long
Since only 1 out of 16 patients that had a sustained molecular response relapsed in 9 years, IMO a sustained molecular response after allo should be considered a functional cure. I do agree that a patient cannot "pop a pill" and be functionally cured. I think the patients are asking for too much to think a drug could cure a blood cancer like myeloma. Potentially a vaccine type of approach could be found. It likely would have to be given to a patient in first remission to be effective. Unfortunately, the concept of a myeloma vaccine has been around for a long time and none have proven effective. IMO it takes some type of effective immunotherapy to cure myeloma.
I for one would like to thank all the doctors that have worked hard and made allo transplants a much safer and efficient procedure. I do not go to Moffitt, but I know they have put out some great research on allo transplants and very likely have functionally cured some patients. Since allo transplant is a potential cure and great strides have been made in the last decade in allo transplantation, IMO we are making great progress toward a cure in myeloma for the younger patients. Keep up the great work Dr. Shain!
Mark
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Mark
Re: Time until a cure for myeloma
Until they find the cause they probably will not find a cure.
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sailor466
17 posts
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