I wrote about a Czech Republic study Sunday and Monday, which concluded adding novel agent maintenance therapy extends median life expectancies in Stage I and II multiple myeloma patients. That’s old news. The eye-opener for me was the study’s contention that the median life expectancy for myeloma patients who received stem call transplants (SCT), followed by maintenance therapy using thalidomide (Thalomid) or bortizomib (Velcade), exceeded ten years. Even in this study, that may be a stretch. One of our readers, Jerry, points out only 1/3 of the patients were alive after ten years. I responded in yesterday’s comment section “1/3 patients alive after ten years is still pretty good, don’t you think?” Here is a more sobering report I found in The Oncologist over the weekend which clearly states: “Multiple myeloma remains an incurable disease, with median survival rates of 4-6 years even with aggressive, high-dose chemotherapy, bone marrow transplantation, and intensive supportive care.” Ouch! Did my life expectancy just get cut in half? Here’s the report:
Nontraditional Cytotoxic Therapies for Relapsed/Refractory Multiple Myeloma
Mohamad A. Hussein Contradicts Czech Republic Study
Cleveland Clinic Myeloma Research Program, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio, USA
Correspondence: Mohamad A. Hussein, M.D., Cleveland Clinic Myeloma Research Program, The Cleveland Clinic Taussig Cancer Center, 9500 Euclid Avenue, Desk R35, Cleveland, Ohio 44195, USA. Telephone: 216-445-6830; Fax: 216-445-3434; e-mail: firstname.lastname@example.org
Multiple myeloma remains an incurable disease, with median survival rates of 4-6 years even with aggressive, high-dose chemotherapy, bone marrow transplantation, and intensive supportive care. Additionally, multiple myeloma is primarily a disease of the elderly, many of whom cannot tolerate aggressive chemotherapy. Thus, newer treatments with good safety profiles are needed to improve the quality of responses and, hopefully, to translate into prolonged progression and overall survival. The pathophysiology of multiple myeloma is complex, involving many pathways and interactions among cytokines, adhesion molecules, angiogenesis, and mechanisms of resistance, which, taken together, provide multiple targets for novel therapeutic modalities. Agents currently under investigation for treating multiple myeloma include thalidomide and its successors, PS-341, and arsenic trioxide. Thalidomide and immunomodulatory drugs both exhibit activity against multiple myeloma by affecting different levels of the immune system. PS-341 is a proteasome inhibitor that halts the cell cycle, resulting in apoptosis; it also inhibits a key transcription factor and may have antiangiogenic activity. Arsenic trioxide activates multicellular mechanisms to induce apoptosis, inhibit angiogenesis, and stimulate immune responses. Preclinical and early clinical data suggest that combination regimens should be pursued, given the different mechanisms of action of these compounds on the immune system and their non-overlapping toxicities at low dosages.
My reason for posting this abstract report wasn’t excitement over PS-341 or arsenic trioxide. Maybe these drugs will come to market some day and help us–along with a dozen others. No, it was the introductory line about median life expectancy of patients undergoing SCT and aggressive novel therapy treatment only being 4-6 years. This is more in line with numbers I have heard quoted before.
Still, I must admit it is more than wishful or hopeful thinking when I share with you that I, as well as many myeloma docs, nurses, other informed patients and researchers, believe the 4-6 year numbers to be very low and out of touch. Tomorrow I will share some anecdotal evidence (Isn’t that the best kind–especially when you agree with it!) supporting my gut feelings about this patient longevity issue.
Feel good, keep smiling and stay hopeful! Pat