Increasingly Improved Outcomes for Multiple Myeloma
Insights From: Rafael Fonseca, MD, Mayo Clinic; Gareth Morgan, MD, PhD, UAMS Myeloma Institute; Thomas G. Martin, MD, UCSF Helen Diller Family Comprehensive Cancer Center
Rafael Fonseca, MD: The outcomes for patients with multiple myeloma have improved dramatically over the past several years, and that is truly a reflection of the better tools we have for the treatment of the disease. When I finished my fellowship, no one wanted to treat myeloma because we had very few tools and, at that time, the median survival measured approximately 2 to 3 years. It’s not unusual now for us to see patients who are alive for 8 to 10 years. In fact, we just published a study earlier this year in Leukemia where we looked at close to 10,000 myeloma patients, and it’s a neat new system to do research with. We actually cross referenced a database of a commercial insurance company, something called Truven Health Analytics, with the Social Security Administration death records, so we could actually create Kaplan-Meier survival curves. We showed that even over the last several years, we continue to see an improvement in the survival for patients with myeloma.
Gareth Morgan, MD, PhD: There’s a strong rationale for using combination regimens in multiple myeloma. Historically, we’ve treated most of the hematopoietic cancers with combinations. The aim in this is to select different mechanisms of action of the drugs and different side effect profiles. And so, if you combine the drugs, you can get additive value and synergistic value. In lymphomas, it was shown that combinations really work well. And so, I’ve been interested in this question in myeloma. We can show that at presentation it’s not just 1 clone, but that within the clone there’s heterogeneity of some sensitive cells, some resistant. It’s very logical that to kill as much of the cancers cells as possible, you use a combination and aim for a deep, deep response.
Rafael Fonseca, MD: Over the last 5 years, we have changed how we think about the goals of therapy for a newly diagnosed patient with multiple myeloma. Anyone reading a textbook from 10 years ago would see in the first-line setting that myeloma is an incurable disorder. However, we know that with optimal therapy one can provide very durable control of the disease with the induction therapies we have and with stem cell transplantation. So, I would say that for the patient we see nowadays, particularly that patient who will be a stem cell transplant candidate, we’re thinking about going for the cure. Now, that’s only a small minority of patients right now, probably somewhere between 10% and 20% of patients, but we’re looking for very deep and durable remissions. We’re looking at the best induction regimens, the best combinations, followed by transplant, and that is usually followed by a maintenance approach.