Hardly a day goes by when I am not inundated with the news of incredible advances that have been made in the treatment of multiple myeloma.

Survival rates have gone from three years to five years and now to eight to ten years.

Five new drugs have been approved for the treatment of myeloma over the last decade.  A couple of dozen more are in various stages of clinical trials.

We are tantalized by the promises of “breakthroughs” just on the horizon.

Immunotherapy hopes to harness the body’s own immune system to fight myeloma.  Genomics holds the potential of uncovering the genetic mutations that trigger multiple myeloma, allowing researchers to design drugs that specifically target these mutations.

I suspect that as exciting as these things are, they are going to be much more complex and take much longer to work out than we are often led to believe.

The history of cancer research has been littered with broken promises and unmet expectations.  In the early 1970s, President Richard Nixon declared a war on cancer.  Yet, here we stand over 40 years later.

To be sure, there is much to be thankful for.  For example, I just reached the eight-year anniversary of my diagnosis.

There is no doubt that I would not be alive today without the advances that have been made.  But is it good enough?

I am refractory to all of the U.S. Food and Drug Administration (FDA)-approved drugs and have exhausted all the standard treatments.

Multiple myeloma is still considered an “incurable disease.”

So, is the glass half full or half empty?  It depends on how you look at it.

I recently had the pleasure of attending a wonderful dinner for multiple myeloma patients.  It was organized by fellow Myeloma Beacon columnist Pat Killingsworth.

Each person got up and briefly told their “myeloma story.”

Now, granted, this was a self-selected group that may not have been completely representative, but I was struck by the wide spectrum of stories and how well most of the people were doing.

One woman had been on just thalidomide ^[1] (Thalomid) for 10 years and was doing fine.  Many had achieved complete responses and were stable on nothing or their current regimens.

For many of them, it might seem as though the myeloma treatment glass is half full.

Very few seemed to be in my situation with advanced, aggressive disease.  I began to think that these people don’t even have the same disease as me.

It is apparent just from reading the various other Myeloma Beacon columns ^[2] how varied the disease course and response to treatment is.

Herein lies part of the problem.  Multiple myeloma is really a wide spectrum of diseases with different behaviors.  How one views the current state of myeloma treatment depends on where you are on that spectrum.

“Treatable but not curable” is how multiple myeloma is described.  But “treatable but not curable” can look like many different things.

Toenail fungus is treatable but not curable.  Diabetes is treatable but not curable.

But relapse is still the norm.  Even those who are stable and doing well have the constant specter of knowing that the disease can become refractory and turn nasty and aggressive at any time.

So what should we all make of the current state of multiple myeloma drug development and treatment?

The pace of drug development has been more rapid than in many cancers, and some of the improvements have been impressive.  But the advances are incremental. There has not been a ground-breaking, game-changing drug.  There is too much emphasis on modifying existing drugs, which results in drugs with new names and modest improvements.

There is, however, a promising pipeline of new categories of drugs with different mechanisms of action.

The monoclonal antibodies are on the forefront of this list.  Elotuzumab ^[3] and daratumumab ^[4] are leading the way, and at least one will likely be FDA-approved in the next year or two.

Drugs that target other pathways such as KSP inhibitors and HDAC inhibitors, among others, are in clinical trials and are showing promise, but again, they are not necessarily game changing.

Clinical trials are still too limiting, cumbersome, and time consuming.  Overcoming drug resistance is still a big issue.  The complexity and heterogeneity of the different multiple myeloma subtypes and which drugs work best for a given situation is likely many years away from being resolved.

Many try to just stay alive until the next drug.  But that next drug may not come fast enough.

We have come a long way, and that’s good.  Is it good enough?  It depends on where you are.

Is the myeloma treatment glass half full or half empty?