One of the areas that we are all looking out for is the use of immunotherapy in multiple myeloma. There are some safety concerns that are being investigated, but immunotherapy has encouraging results in other settings. Therefore, we are all very anxious to see whether immunotherapies will be included as part of myeloma therapy or not.
What are your thoughts on the clinical trials that were halted in multiple myeloma with checkpoint inhibitors?
I was not aware of any safety concerns in phase I trials with immunotherapy. But then with the later-phase trials, safety concerns began to be more noticeable. Therefore, one of the questions is whether immunotherapy should be used as a single agent, and maybe in combination is where some of the toxicities become more noticeable. Or, perhaps that was a false alarm. We are all anxiously awaiting this analysis.
Can you discuss some of the news that has come out recently about medical marijuana in cancer care?
This is an area that I find very interesting; I receive at least 1 question from patients every day about it. There has been a lot of information in the press about the benefits of marijuana in dealing with cancer-related symptoms, such as decreased appetite. We definitely think there is going to be room for using marijuana in our day-to-day practice. The questions are, “How is it going to be regulated and how is it going to be prescribed?”
It has been legalized in medical practice in Ohio, but there are no dispensaries yet. Therefore, it is legal but not available.
If it becomes available, how do you see it altering the future of the treatment of patients with cancer, especially hematologic malignancies?
A lot of it will depend on the regulations, pricing, how easily it can be prescribed, and how easily it can be obtained. For every practicing oncologist who is managing patient symptoms, improving their quality of life is a priority. We always welcome any new modality that would help patients with their quality of life.
Most treatments can cause nausea and depressed appetite, so the use of marijuana could eventually be seen across hematologic malignancies, as well as solid tumors.
Is there anything else you would like to add?
One of the areas that has gained a lot of interest in the oncology world is targeted therapies. This is an area that I have worked in for some time, using platforms that evaluate for targets in the community setting. The good news is that such platforms for evaluating targetable mutations are now commercially available, so it can be used by the community oncologist. In many cancers, there is a direct impact on selection of treatments for patients. Fifty years from now, this is going to be our day-to-day practice, so it is considered an evolving field.
- Palumbo A, Chanan-Khan A, Weisel K, et al. Daratumumab, bortezomib, and dexamethasone for multiple myeloma. N Engl J Med. 2016;375(8):754-766. doi: 10.1056/NEJMoa1606038.
- Dimopoulos MA, Oriol A, Nahi H, et al. Daratumumab, lenalidomide, and dexamethasone for multiple myeloma. N Engl J Med. 2016;375(14):1319-1331. doi: DOI: 10.1056/NEJMoa1607751.