Pleas read this excerpt from a transcript which is part of a CME credit program for physicians, produced by MedPageTODAY:
SMITH: I’m Michael Smith of MedPage Today, and I’m here with Dr. Stan Gerson, Director of the Seidman Cancer Center at University Hospitals Case Medical Center in Cleveland. Dr. Gerson, welcome to MedPage.
GERSON: Thank you.
SMITH: We’re going to talk today a little bit about multiple myeloma and, in particular, a tough group of patients, those with relapsed or refractory disease — the difficulties of choosing appropriate therapies for those people, some of the complications that they might run into, and then some of the new drugs coming down the pipeline. It’s an interesting time in multiple myeloma because there have been a number of new agents and there are a number of combinations available, but let’s begin by talking about the kinds of challenges, disease-related, regimen-related, and patient-related. What sorts of things must a clinician be aware of, I guess?
GERSON: Well, everyone with myeloma will relapse, and everyone with myeloma will end up with some sort of level of refractory disease. Even patients who go through a stem cell transplant often will relapse, so this is a very common issue. Many of the issues in the management relate to the age of the patient, how much therapy they’ve had and how much they can take, the types of complications they have — in addition to the diagnosis of being relapsed — and what they have received before. On the other hand, the optimism is that, for almost all of those patients, there’s always a treatment that can be delivered.
SMITH: And that’s actually a relatively new thing. We’ve had a number of agents come down the pike in the last eight to 10 years, that in some sense have changed the face of multiple myeloma. There’s thalidomide, bortezomib, and lenalidomide, which is of course a thalidomide variant. Tell me about those. What do we know about those drugs? What sorts of results can they deliver?
GERSON: Well, they are just phenomenal. There’s about a 40% response rate with any one of the individual drugs. That response rate is improved simply by taking one of the chemotherapy drugs that you’ve described and adding a steroid, such as dexamethasone, and then adding combinations increases the response rates to 50, 60, 70, or even 80%. So the initial response rate is terrific. What’s really interesting about myeloma is that, even at relapse, these patients will respond to the other agents. Sometimes they’ll even respond to the initial agent that was given.
SMITH: That’s fascinating. So what you’re saying is that if I, for instance, have multiple myeloma and I fail a course of treatment with one of the thalidomide derivatives, I can go to another one; I don’t burn the class.
GERSON: That’s absolutely correct. And so, very meaningful responses can be observed for years in patients who go from thalidomide to lenalidomide, for instance.
So how does reading this make you feel? Like Dr. Gerson, would you term the treatment options available to us as multiple myeloma patients “phenomenal?”
I wanted to try and duplicate how I feel when I cover multiple myeloma events like ASH and ASCO.
On one hand, Dr. Gerson is correct. I can’t think of another cancer where oncology has made more progress over the past decade.
But a myeloma patient could justifiably argue that the bar hasn’t been set very high! Oncology research moves at a glacial pace when one looks at it from a patient’s perspective.
So it can be difficult for me to sit and listen to presentations by researchers and myeloma experts and stay objective. On one hand, I understand how advances in myeloma therapies are far outpacing the norm.
But as a patient, I want things to move so much faster! It can be excruciating watching this stuff day to day in real time! It seems to move so slowly!
Back to your feelings about the excerpt. How does it make you feel to read, “Well, everyone with myeloma will relapse, and everyone with myeloma will end up with some sort of level of refractory disease. Even patients who go through a stem cell transplant often will relapse…”
Deep down, we all know it’s true. But isn’t it hard read or hear this type of thing? Come on, admit it. Some of you believe that you will be one of the select few that achieves a truly long term remission!
Nothing wrong with being hopeful–as long as it doesn’t cloud your judgement.
And by the way, I have met–and I read about–patients that go six, eight or even ten years after any number of different treatments relatively myeloma free.
As a matter of fact, Dr. Gerson sites just such an example in this training exercise.
Here is a link to the short CME course site:
There you will find both a transcript and video of the academic interview between MedPageTODAY’s Michael Smith and Dr. Gerson.
Myeloma patients and caregivers need to be able to read about or watch reports like this objectively. It’ all part of becoming a better informed patient.
But that doesn’t mean it will always be easy. So what else is new!
Feel good and keep smiling! Pat