I wanted to squeeze in another of Danny Parker’s important columns before things get too busy right before ASH. He shifts gears, beginning to focus on clinical trials and the future of multiple myeloma  research.

Tomorrow I’m working on an update about my health and the visible (and hidden) effects of my choice to complete tandem stem cell transplants. It includes a selfie of me in the pool you won’t want to miss!

One more note before Danny gets started, I wanted to pass along an income earning opportunity. I’ve done work for David’s company. He’s professional and pays promptly. I don’t know anyone with head or neck cancer to recommend, but I thought several of our readers might. Here’s an email David sent me a day or two ago:

Good afternoon, Pat.

We have another project for a client who is interested in speaking with people who have been diagnosed with Head and Neck Cancer. Do you think that you might be able to help us spread the word? Each participant will receive $200 as a thank-you for participating in the 60-minute telephone interview.

The only requirement is that participants must have been diagnosed within the past two years, or so.

Thanks so much,
David
_____________
David Leonard
Director
pfc Opinion Research
New York, NY
Tel: 212.289.0087

Feel free to call him if you can recommend someone. If they’re like me, we can always use the money.

Now for the sixth installment of Danny’s series:

Metformin, Myeloma and Evidence-Based Medicine: The Need for Clinical Trials

Danny-Parker-Two1-150x150I hope Pat’s readers aren’t tiring from my long-winded series on this issue, but I wanted to set out the evidence that there is something here and to make a case for further inquiry.

So what to make of all this?Should myeloma patients be running out to start taking metformin?

No.

We embrace evidence-based medicine. The evidence is not yet conclusive.

Pyramid

Within treating myeloma, the medical research community seeks to protect us from flawed and ineffective treatment as well as over treatment. Approved medical treatment for myeloma needs to be based on the proven ability of treatments to help us more than they might harm us. And this needs to be proven in randomized clinical trials in a statistically convincing fashion, ideally replicated in different settings, patient populations and by different researchers.

This is the foundation of evidence-based medicine. And as myeloma patients, we should be very grateful to the tireless genetic scientists, myeloma researchers and oncologists who seek to bring its power and safety to our treatment.

For a moment, let’s go back to the compelling research from the Chang et al. (2015). This work shows an almost undeniable association in the difference in the progression of diabetic MGUS patients to myeloma depending on whether they are taking metformin or not.

However, a key thing about MGUS patients is that this problem is common whereas only about 10% of these patients will develop myeloma over their lifetime. Remembering the Hippocratic Oath—do no harm– the risk to treat such a massive population, often unnecessarily, could far outweigh the benefits.

On the other hand if one is an MGUS patient with high serum blood glucose, then seeing an endocrinologist to prescribe metformin might be a reasonable course of action—particularly if the MGUS was classified as the high risk variety.

However, to recommend taking metformin as a high risk MGUS patient would require rigorous clinical trials and not just cohort studies or case-control evaluations of the type I have cited in preceding weeks.

Sorry, not yet ready for prime time.

Good advice. But blood sugar issues? Work on the diet and exercise part, then discus the possibility of starting a course of metformin with your doctor. I look at it like Cialis. The erectile dysfunction drug has shown some anti-myeloma properties early on; enough so that there are ongoing clinical trials using it.

So, if you are struggling with ED–and who isn’t after enduring things like stem cell transplants and ongoing maintenance over the years–why not try the daily dose? Look into it. Check the dosing numbers in the Cialis trial. Like metformin, I call that “double dipping.”

By the way, I’m way past drugs like Viagra and Cialis helping me. Regrettably, it’s been over five years. I’d write more about it, but unlike me–a wide open book–my wife is a very private person.

I’m excited to follow Danny as he delves into world of myeloma research, explaining why it’s been so difficult to crack the myeloma drug resistance code.

But with ASH looming Friday, we’ll pick things up later next week. Thanks again for all your hard work, good friend!

Feel good and keep smiling! Pat