Improving Quality of Life for Multiple Myeloma Patients
Education & Research The Food and Drug Administration recently approved several new drugs some say can revolutionize the treatment of multiple myeloma and, in particular, patients facing a relapse.
“We have come a very, very long step forward in the past 15 years,” says Dr. C. Ola Landgren, the chief of the myeloma service division of hematologic oncology at Memorial Sloan-Kettering Cancer Center. Today, he explains, there are approximately 10 drugs available in the fight against multiple myeloma—compared to the one or two we had 15 to 20 years ago.
How we’re fighting
The number of new drugs available—monoclonal antibodies, proteasome inhibitors and immunomodulatory agents—are doubling and tripling survival rates. “This gives patients hope,” chimes in Dr. Joseph Mikhael, associate professor of medicine at Mayo Clinic and spokesperson for the American Society of Hematology.
We have yet to develop a cure for multiple myeloma, a rare cancer that affects plasma cells normally found in the bone marrow. Plasma cells produce antibodies called immunoglobulins that help fight infections and other diseases. When plasma cells become malignant, the cells produce a tumor called a plasmacytoma, which normally develops in a bone. Persons with more than one plasmacytoma have multiple myeloma.
Are you at risk?
About 25,000 new cases are diagnosed each year, and the average age of onset is 70. It is more prevalent in African-Americans. Over 95,000 people in the U.S. are living with, or in remission from myeloma. There were an estimated 11,000 deaths in 2015.
“'When we talk about quality of life, we look at how well we manage the side effects.'"
The disease produces proteins that are detectable in blood and urine while the patient is asymptomatic. “A very small percentage develops multiple myeloma,” says Dr. Landgren. “We want to prevent it before it happens.” The disease primarily affects the blood, bones and kidneys and, once it does, is “difficult to treat,” confirms Dr. Mikhael.
“There is no known cause,” Dr. Landgren adds. Research suggests that environmental factors, such as exposure to pesticides, may play a role, and that genetic factors may trigger the development of the disease.
It’s important to initiate treatment at the right time. Early intervention may delay or prevent progression of the disease. Says Landgren: “We want to catch it before it goes out of control.”
New treatment options are enhancing the quality of life for patients, who are able to live normal lives. “When we talk about quality of life, we look at how well we manage the side effects. It’s a subjective measurement,” Mikhael explains. “Proteasome inhibitors are a huge step forward.” Late this January, the FDA approved a new indication for Carfilzomib, making it the only approved therapy for relapsed multiple myeloma, with proven efficacy as a single agent, doublet and triplet combination.
Two new monoclonal antibodies, Daratumumab and Elotuzumab, are the first FDA-approved drugs that engage the immune system and destroy the tumors. Immunomodulatory drugs are also proving effective against multiple myeloma.
“Every patient will have a relapse,” confirms Mikhael. The new drugs show a lot of promise and new drug combinations are being studied that will help patients remain in remission longer with fewer side effects. Some patients are now in remission for a decade or longer, and the average survival rate has increased, from 3 to 4 years, to 9 to 12 years.
“It’s important to monitor the treatment response,” Landgren says. If patients have a negative response to treatment, for example, the therapy can be stepped down to a lower intensity. It’s important to maintain drug therapies at a level where the disease doesn’t become active.
Science and research must build a thorough understanding of this disease to develop effective drugs. From there, patients will begin to live longer, better lives. “Many still die every day,” Dr. Mikhael says. “We still have a long way to go.”