Professor Paul Browne
Professor of Haematology at Trinity College, Dublin
The outlook for patients with relapsed and refractory myeloma has never been better and even more new treatments are on the horizon.
“Twenty years ago, the average life expectancy of someone diagnosed with myeloma was just three years,” explains Paul Browne, Professor of Haematology at Trinity College, Dublin. “Now people live 10 years and well beyond.”
In fact, survival rates for patients with myeloma, a form of bone marrow cancer, have improved more rapidly than for most other cancers, according to statistics published by the Irish National Cancer Registry.
While there remains no cure for this relapsing-remitting cancer, which recurs after periods of remission, a diagnosis no longer comes with the sense of fear it once did. With regular blood tests, doctors can track the disease more accurately enabling timely and effective treatment.
“Although you may not be cured, with the right treatment you can live well for many years. It’s more like living with a chronic disease, such as diabetes,” continues Browne.
Advancements in myeloma therapy
The improved outlook can be attributed to the range of drugs now available to treat the condition. Over the last decade, there has been a move away from chemotherapy and stem cell therapy, in favour of new classes of drugs that can be used together to achieve higher success rates.
These include proteasome inhibitors that block the development of proteasome within a cell, resulting in a protein build up that eventually kills the myeloma completely. There are also immunomodulatory drugs that work by killing myeloma cells directly, reducing the blood supply to myeloma cells, preventing myeloma cells sticking in the bone marrow, and boosting a patient’s immune system.
Survival rates for patients with myeloma, a form of bone marrow cancer, have improved more rapidly than for most other cancers.
Another group of drugs added to the list are known as monoclonal antibodies. These antibodies are designed to work against certain proteins found in the body, and can be used to target and attack myeloma cells. They can be used at different stages of myeloma.
All these treatments are highly targeted, improving success rates and reducing damage on surrounding healthy cells. They’ve also proven to be highly effective in patients with relapsed and refractory myeloma.
Progress continues but requires further funding
While access to these therapies is generally good, Browne warns against complacency. “We do have a challenge with access to monoclonal antibodies and we also need to consider funding structures for developments that are coming,” he says.
Browne is specifically referring to CAR-T therapy recently licensed for use in adult patients with relapsed and refractory B-cell lymphoma and children with acute lymphoblastic leukaemia.
The highly complex treatment involves collecting and using patients’ own white blood cells, modifying them to attack the cancerous cells and then putting the cells back into the body by means of a special transfusion.
CAR-T therapy is not yet available to treat myeloma, but clinical trials are promising. “Within the next 12-18 months, we hope to see CAR-T therapy licensed for use,” confirms Browne.
With advancements in technical knowledge, clinical developments and a spirit of collaboration, Browne believes there is no reason why the current trajectory of progress can’t continue. And, if it does, perhaps that elusive cure won’t be a pipe dream for much longer.