Thought Leader Perspective: Dr. Kenneth Anderson On The Future Of Myeloma Treatment
Dr. Kenneth Anderson, a world-renowned myeloma specialist, physician and researcher at Dana-Farber Cancer Institute, and Kraft Family Professor at Harvard Medical School, spoke with The Myeloma Beacon about his approach to treating multiple myeloma patients.
This article is the second part of a two-part series based on The Myeloma Beacon’s interview with Dr. Anderson. It will cover Dr. Anderson’s thoughts on where myeloma treatment is headed in the coming years. For more information on Dr. Anderson’s current approach to treating multiple myeloma, please see part one of this series.
Emerging Therapies
According to Dr. Anderson, there are several promising agents being developed to treat multiple myeloma.
The first promising agent that he discussed was carfilzomib, a proteasome inhibitor like Velcade (bortezomib). “Carfilzomib appears to be active in relapsed myeloma and very well tolerated with very little in the way of neuropathy [pain or tingling in the extremities],” Dr. Anderson explained.
He was also impressed with pomalidomide’s potential. Pomalidomide is an immunomodulatory drug like thalidomide (Thalomid) and Revlimid (lenalidomide). “Pomalidomide, like thalidomide and Revlimid, targets the tumor in the microenvironment, but excitingly pomalidomide is active even when thalidomide and Revlimid are not. Pomalidomide is also active when Velcade is not.”
Besides these two investigational drugs, Dr. Anderson saw the most potential in combinations of treatments.
Dr. Anderson mentioned combinations of Velcade and a histone deacetylase inhibitor, either Zolinza (vorinostat) or panobinostat (Farydak), which have achieved responses in the majority of patients who have not responded to Velcade.
He also felt that Velcade in combination with the AKT inhibitor perifosine appears to be effective in patients who have previously been treated with or did not respond to Velcade.
In combination with Revlimid and dexamethasone (Decadron), Dr. Anderson was most excited about the addition of the antibody elotuzumab. He said that this combination has achieved a very high response rate in myeloma patients.
Personalized Therapy
In the next several years, Dr. Anderson thinks that personalized therapy for multiple myeloma patients will become more and more common.
He explained that myeloma patients can be treated differently based on their genetic profile. However, he said, “We first need to be better able to profile patients to determine who is likely to respond to which treatment; and secondly, personalized medicine in myeloma will require us to develop more targeted therapies.”
If advances are made in these two areas, Dr. Anderson said, “I would think over the next three to five years that personalized treatments will occur.”
Myeloma Stem Cells
In the coming years, myeloma specialists also hope to better understand myeloma stem cells, the cancerous cells that reproduce and may be responsible for relapse of the disease.
“So far, we have not been able to reproducibly identify that stem cell, but there is great emphasis on trying to understand its biology so we can effectively target it,” said Dr. Anderson. “Ultimately, in order for cure to occur, the ability for myeloma to return and cause relapse will have to be overcome.”
Cure For Myeloma
Many myeloma specialists differ in opinion about the goal of treating multiple myeloma patients.
For some, the goal is to cure myeloma patients by achieving and maintaining a complete response or eliminating all traces of myeloma. Others argue that the aggressive treatment needed to nearly wipe out the myeloma cells can severely impact a patient’s quality of life, and yet the patient is still likely to relapse. Many of these physicians would prefer to get the disease to a safe level and then treat to control the disease while maintaining a high quality of life for the patient.
When asked his opinion in the debate, Dr. Anderson replied, “Absolutely, the goal should be to cure our patients.”
“I strongly think that in the era of novel therapies, used in combination and as maintenance, sustained complete responses will be achievable in the majority of patients,” said Dr. Anderson. “First achieving complete responses and then sustaining those complete responses is, in fact, the pathway towards cure, and I do think we’re closer to that goal than ever before.”
Dr. Anderson said that this approach does not have to significantly impact quality of life. “Quality of life is obviously paramount and of the highest importance,” he said. “The good news is that novel therapies used appropriately really are also very well tolerated.”
“I don’t think it needs to be one or the other. I think we can actually achieve high response rates, and fortunately, they are associated not only with living longer, but living longer with a quality life,” he added.
Advancing Research Through Clinical Trials
Dr. Anderson said that the quickest way for advances to be made in the treatment of myeloma is for patients to participate in clinical trials. “I would most enthusiastically urge patients to endorse the concept of clinical trials and ask patients to participate whenever possible.”
He said patients should participate because “you will get top notch, cutting edge, novel treatments that will give you the best possible chance for doing well in myeloma.”
For those who are concerned about randomized clinical trials, in which half of the patients receive the standard of care instead of the study drug, Dr. Anderson said, “We don’t know which of the options are better. Usually in a randomized trial, there is the opportunity later on to receive the treatment that you were not chosen to receive if it in fact is beneficial. In other words, a patient often ends up receiving the new medicine either right away or later.”
Dr. Anderson concluded by saying, “I think it’s a very exciting time in myeloma, and it’s a unique privilege for all of us to help, together with our patients, improve the outcome in this disease.”
For more information about Dr. Anderson’s approach to treating multiple myeloma, please see part one of this series.
Related Articles:
- Nelfinavir Shows Only Limited Success In Overcoming Revlimid Resistance In Multiple Myeloma Patients
- Lather, Rinse, Repeat: Will It Work With BCMA-Targeted Therapies For Multiple Myeloma?
- Adding Clarithromycin To Velcade-Based Myeloma Treatment Regimen Fails To Increase Efficacy While Markedly Increasing Side Effects
- Nelfinavir-Velcade Combination Very Active In Advanced, Velcade-Resistant Multiple Myeloma
- Revlimid, Velcade, and Dexamethasone, Followed By Stem Cell Transplantation, Yields Deep Responses And Considerable Overall Survival In Newly Diagnosed Multiple Myeloma
I would like to know other people's symptoms M.M.
Julie. A superb job capturing Dr. Anderson's thoughts. You asked the right questions and he provided clear answers reflecting his opinions.
I thought his choice of words in response to your question on quality of life following treatment was particularly revealing "The good news is that novel therapies used appropriately really are also very well tolerated.” The key phrase "used appropriately" hints at the individualizing the dosing initiative which I am promoting. Eveyone should have personalized treatment with individualized dosing.
Connie, you can read about the signs and symptoms of myeloma in our Resources section: http://www.myelomabeacon.com/resources/2008/10/15/signs-and-symptoms/
You can also find lots of information in our forums: http://www.myelomabeacon.com/forum/ Feel free to post a question about symptoms there. You'll hopefully get responses from a number of people living with myeloma.
Gary, thanks very much for your kind feedback.
Great work again!!!
I had the hope to hear a little bit more about experimental phase I/II agents. As experts say myeloma is still a disease with "high unmet medical needs" I'm of course intersted if and how the gap will be filled. The new stars carfilzomib, pomalidomide and elotuzumab are "news" since ASH 2009.
So more questions about the future are emerging: What about the cd38/cd52-antibodies, the hsp90/hif-inhibitors or oral available forms of the existing agents (like ONX 0912). What about learnings in first- and second line SCT and stem cell research? And what does Dr. Anderson think about vaccines (your last series) and basic research (myeloma stem cell is a very investigational path since 2002 and Matsui et al think about them to be investigational for a long time) (link)
I want to point out that the beacon is the best publication I could imagine for us patients and I'm a great fan. Thank you very much for this feature again!
Peter
Peter, thanks for your compliments about The Myeloma Beacon.
Unfortunately, it's just too early to tell about many Phase 1 or even Phase 2 drugs, or they aren't showing as much potential as pomalidomide and carfilzomib did at that stage. The bright side is that the most promising agents are closest to approval. Hopefully by the time those are approved, more developmental drugs showing strong potential are likely to emerge.
I didn't specifically ask Dr. Anderson about myeloma vaccines, but he also did not mention them when we discussed the most promising emerging therapies or personalized therapy.
I was overweight and type 2 diabetic. My Endocrinologist noticed a decline in my red blood cell count over a period of years and became concerned about it. I went to a hematologist/oncologist who questioned my eating, drinking habits and advised that it might be the result of to much alcohol consumption or possibly something worse. He offered that I stop drinking for a while or a bone marrow biopsy. I choose to stop drinking but did not see an increase in red blood cells and he advised that I should probably have the biopsy. I was waiting to act on that advice when I put back out. Turns out that I had two stress fractures in my lower spine. A renal bone survey and blood tests finally determined the myeloma. I would suggest that anyone who notices a decline in their red blood cell count get tested for Muliple Myeloma.
I would like to hear estimates on when some of these drugs might be available.
I've had MM for 18 months and 18 months ago, Pomalidomide was going to be available real soon. What is the status and does anybody have an estimate on when it will be available?
Same questions for Carfilzomib?
Thanks for having such an informative forum.
Hi Stan,
Onyx is planning to complete their submission to the FDA for the approval of carfilzomib as early as mid-2011. If carfilzomib receives priority review, then the FDA would review Onyx's application within 6 months.
The timeline for pomalidomide is not as clear. Some sources are stating approval by mid-2013. However, if Celgene receives accelerated approval for pomalidomide based on its Phase 2 data, some financial analysts believe Celgene could file for FDA approval late this year.
I was diagnosed this past January with MM (having manifested two tumors at T9 and T12). Have had a round of radiation to stabilize those tumors, as they were threatening my spine with a real possibility of paralysis (there has been some significant degradation of bonemass, esp. at T12)
Thank you for both this website, and this most excellent and encouraging interview... much of the data I have been finding online has left me rather pessimistic. The more current data seems much more positive... it's good to know that MM is not a sure-thing death sentence anymore!
John, thanks very much for your kind words about The Myeloma Beacon and the interview with Dr. Anderson. You're absolutely right that the outlook for myeloma patients is becoming more and more positive as additional drugs and combinations of drugs are being tested and used to treat myeloma.
We wish you the best and hope that your physicians are able to stabilize the tumors in your spine. Likely, you are already on a bisphosphonate for your bone disease, but you may also want to ask your physician whether vertebroplasty or kyphoplasty (two types of spinal surgeries) may help to stabilize your spine or alleviate any pain you may be having.