Confused about the wide range of multiple myeloma treatment philosophies and options? This research article from the latest Journal of American Hematology, called Blood, is a must read for anyone who is actively being treated for multiple myeloma.
Please don’t be intimidated. Why it may look imposing and difficult to understand at first glance, this article is remarkably easy to follow–especially for someone who reads my blogs and the Myeloma Beacon regularly.
Here a are a few important excerpts:
Approach to the treatment of multiple myeloma: a clash of philosophies
S. Vincent Rajkumar, Gosta Gahrton, P. Leif Bergsagel
In this Perspective, we summarize some of the most contentious issues surrounding diagnosis and treatment of myeloma. We outline how a fundamental clash of philosophies, cure versus control, may be at the heart of many of the controversies. From the very definition of the disease to risk stratification to the validity of current clinical trial endpoints, we highlight the major areas of debate and provide alternative viewpoints that have implications for trial design and interpretation, as well as clinical practice.
Rather than simply reproduce the abstract and then provide you with a link back to the journal page, I wanted to include several more important points that Dr. Rajkumar makes in the body of the paper:
…The current treatment of myeloma varies considerably across institutions and across countries. Part of this variation is the result of availability and cost of new drugs, but part of it may be related to differing treatment philosophies and alternative interpretations of the available data…
…there is no question that the survival of MM patients has improved significantly in the last decade…
…However, there are certain fundamental issues that investigators in the field disagree on, which in our opinion need to be carefully studied and debated…
The CR Myth: There is no free lunch
…This is a difficult topic to cast doubt on because, after all, who can be against CR? The main reason to be cautious in espousing CR is the correlation between increased response rates and increased toxicity. Striving blindly for CR may lead to unacceptable and unnecessary toxicity for some patients and come at too great a price…
Cure vs Control
…The points discussed in this Perspective are indicative of a broader clash of philosophies in MM: cure versus control…
…The cure-versus-control debate colors our interpretation of clinical trial results, with well-meaning investigators interpreting the same clinical trial data in opposite ways, depending on whether they ascribe to the cure or control philosophy as they approach the care of patients with MM…
This is a compelling article, hitting the key points which are most important to multiple myeloma patients.
Unfortunately, the conclusion is empty and unsatisfying. Because, like multiple myeloma itself, this retrospective leaves us hanging. Which approach is best? How will the availability of a new generation of novel therapy agents influence how doctors treat their patients?
No answers. Only more questions. So much so, the authors don’t even include the standard “Conclusion” section at the end of their paper.
Even so, please read this new discussion about the pros and cons of “cure vs control.” Click HERE to access the article. Let me know what you think.
Feel good and keep smiling! Pat