Making research count for patients – the multiple myeloma story

Research is behind improvements in myeloma treatment

This year at the ASCO conference in the US, several sessions reflected on the rapid progress that has been made for different cancers. We’ve already reported back on the exciting melanoma trial results, which stole the show.

Another exciting highlight was the session on progress in multiple myeloma – a cancer of the bone marrow.

Only a few decades ago, most people with multiple myeloma would only survive for a couple of years after being diagnosed. As US cancer researcher Dr Kenneth Anderson, told the conference, today’s combination treatments mean that some patients will now live for 10 years or more after treatment.

Dr Anderson was the 2011 recipient of ASCO’s highest award – the Karnofsky Memorial Award – in recognition of his outstanding accomplishments in multiple myeloma research. He credited the improvements in outlook to the progress in identifying new drug targets and treatments, which have already made a significant impact on the way the disease is treated.

The history of multiple myeloma treatment is not a long one. Up until 1992, a combination of melphalan – a drug that Cancer Research UK was instrumental in developing in the 1950s – and prednisone, was the only treatment available. In the 1980s and 1990s, the introduction of stem cell and bone marrow transplantation came into use, allowing people with myeloma an extra year or two of survival on average.

However, the last decade has seen the introduction of a series of new drugs, allowing some patients to survive for longer. Indeed, latest UK stats [pdf] show that the largest increase in five-year relative survival for both men and women is for those diagnosed with myeloma.

A decade of progress

Dr Anderson talked about the importance of research that has focused not just on the tumour cells, but also on the cells surrounding them in the bone marrow – the tumour microenvironment. Research in this area has established new ways of treating multiple myeloma, with great success.

Three of the key drugs that have been born out of this research are thalidomide, lenalidomide and bortezomib.

Thalidomide and lenalidomide are immunomodulators – they affect multiple myeloma cells in a number of ways – encouraging the immune system to attack and kill myeloma cells, or directly causing the myeloma cells to die.

Bortezomib, on the other hand, is a type of anti-cancer drug called a proteasome inhibitor. It works by interfering with large protein complexes called proteasomes, which are important in controlling cell growth and which are thought to be stimulated when myeloma cells interact with the cells surrounding them in the bone marrow.

By disrupting the activity of these enzymes, bortezomib can directly stop the cancer cells from growing.

This is tremendous progress for multiple myeloma. Dr Anderson placed great emphasis on the importance of collaboration in this success – between industry, academia, regulatory agencies and patient advocates.

The future

Despite some truly fantastic progress in the treatment of myeloma, of course the story does not end here. There is much more to do to ensure that as many people as possible are given precious extra time with their loved ones – around four thousand people each year are diagnosed with myeloma, and unfortunately treatment is not successful for all of them.

Looking to the future, Dr Anderson expects the use of new DNA-scanning technologies to help deliver the promise of personalised medicine to multiple myeloma. The hope is that by understanding each person’s individual cancer, we will be able to better tailor treatment and – ultimately – help many more patients survive their disease for longer.

Nina Callard