Researchers have achieved major strides in the treatment of multiple myeloma in the last ten years with the use of drugs such as thalidomide (marketed as Thalomid), Revlimid (lenalidomide), and Velcade (bortezomib). In conjunction with high-dose chemotherapy and stem cell transplantation, these various therapeutic options have increased patients’ treatment response and remission rates.

In a recent clinical trial involving Total Treatment 3 (TT3), 80% of patients who received up-front chemotherapy, transplantation, thalidomide, and Velcade achieved nearly complete remission. Of those, 90% have not relapsed four years later.

In addition, there are even promising new drugs, such as carfilzomib, in clinical trials for relapsing patients.

Despite the treatment advances of the past decade and promising news from recent clinical trials, multiple myeloma still carries a five-year survival rate of only 34%. Physicians hope that in the future they will be able to manage the disease indefinitely in patients, much like diabetes or hypertension, but achieving this goal will require more detailed study and clinical trials.

In particular, physicians highlight a lack of information about the most effective combinations and sequences of different treatments. “Naturally, as the permutations are vast and robust data on new agent combination outcomes beyond three to four years are lacking, clear directions are only now beginning to emerge,” explained Bart Bologie, MD, PhD, director of the Myeloma Institute for Research and Therapy at the University of Arkansas for Medical Sciences, Little Rock.

Additionally, testing the genetic instabilities and mutations in each patient’s myeloma cells could help physicians to predict each individual’s risk level more accurately and to determine the most appropriate, tailored treatments. Evaluating this information in clinical trials could also help explain why only some individuals respond to a given therapy. Already, rapidly advancing technology in the field of microgene arrays is helping accomplish this objective.

By obtaining better information about treatment sequencing and combinations, as well as patients’ individual risk profiles, “disease control is definitely a realistic goal, and in many cases we are already there,” stated Melissa Alsina, MD, associate professor and myeloma specialist in the Blood and Marrow Transplant Program at the H. Lee Moffitt Cancer Center & Research Institute in Tampa, Florida.

Beyond simply managing multiple myeloma, researchers are also striving for the ultimate goal: a cure. As Bologie emphasizes, “The cure is no longer an elusive goal in myeloma.”

“However, we have now come as far as we can go with available treatments,” states Guido Tricot, MD, PhD, director of the Utah Blood/Marrow Transplant and Myeloma Program at the University of Utah School of Medicine. To ultimately cure myeloma, researchers agree that they need to better understand the make-up of drug-resistant myeloma cells and to develop therapies directly targeted at the mutated myeloma stem cell.

“Until we can eradicate the myeloma stem cell, it will be difficult to cure the disease,” explains David Vesole, MD, PhD, FACP, director of Loyola University Health System’s Blood and Marrow Transplant program. Yet, he believes that physicians could provide “operational cures” in the near future, where they can adequately extend remission and survival rates to a decade and beyond.

Vesole concludes, “The future is promising these goals will come to fruition within the next 10 years.”

The full article can be found in the November 25 issue of HemOnc Today.