This blood cancer remains a “hard nut to crack” to fight because it involves temporary remissions followed by relapses in the majority of patients, but thanks to new drugs survival is extended by years
If today the multiple myeloma it remains a disease that is still difficult to cure definitively, the goal of complete eradication of the tumor can be seen on the horizon. New confirmations in this sense come from the studies presented at the annual congress of the American Society of Hematology (Ash), underway in San Diego (California) which demonstrate, with numbers in hand, the important progress made by scientific research in recent years. «This blood neoplasm, diagnosed every year at approximately 5,600 Italiansmostly over 60s, has seen a real revolution in care with the arrival of many new drugs and patients' life expectancies have significantly improved – he says Paolo Corradini, president of the Italian Society of Hematology (Sie) -. With previous therapies, survival unfortunately stopped at a few years (less than five, on average), also because the disease always or almost always led to relapseswhile now it is around seven-eight years and often reaches 10″.
In particular, a piece of research, exhibited during the plenary session (the one reserved for the most important innovations) of the US conference by Francesca Gayhematologist at the University Hematology Division of the Città della Salute e della Scienza Hospital in Turin, takes a step forward towards the hopes of recovery, indicating how with a new therapy can achieve remission in a high percentage of patientsthe first step towards long-term control and eradication of the tumor.
First of all, let's look at the pathology: which patients are we talking about?
«Multiple myeloma is a lymphoproliferative neoplasm that generally occurs in people over the age of 65, but which can also affect younger patients – replies Gay, who has presented the study to Ash -. The disease, characterized by the accumulation of tumor cells (plasma cells) in the bone marrow and of proteins (monoclonal immunoglobulins) in the blood, causes anemia, bone damage with possible fractures and increased calcium in the blood and kidney damageif not identified early and treated early.”
What are the current standard treatments?
«There are already therapies capable of sending the disease into remission (until reaching what is defined as “negative minimal residual disease”, i.e. not identifiable with current monitoring methods) and keeping myeloma under control for several years – explains Gay , co-lead author of the research -. A first discriminating element in defining the best therapeutic approach are the clinical conditions of the patient. Those aged up to 65-70 years and with good organ function (heart, lung, kidney, liver) are generally candidates for a more intensive therapeutic approach, which includes autologous bone marrow transplant (also called autotransplant, because the cells are taken from the patient himself). The treatment involves a therapy (called “induction”) to induce remission of the disease consisting of four drugs, followed by the transplant, by a subsequent therapy (called “consolidation”) to consolidate the response obtained and, finally, we proceed to a low-dose (“maintenance”) therapy to maintain the response obtained over time. The four cornerstone drugs included in standard care are a monoclonal antibody anti CD38 (daratumumab), a proteasome inhibitor (bortezomib), a immunomodulatory (thalidomide) and one steroid (dexamethasone). These drugs affect different mechanisms necessary for the survival of the tumor cell.”
What is the problem you are trying to solve with the new study?
«This study aims to evaluate the effectiveness and safety of a new therapy of “induction” and “consolidation” in patients with newly diagnosed multiple myeloma (i.e. not pre-treated) and considered eligible for autologous marrow transplant – explains the researcher -. The therapy always consists of four drugs, which belong to the four key classes: an anti-CD38 monoclonal antibody (isatuximab), a second-generation proteasome inhibitor (carfilzomib), a second-generation immunomodulator (lenalidomide) and a steroid (dexamethasone). It is a new combination of medicines with the aim of evaluating the rate of minimal negative residual disease (i.e. the absence of tumor cells identified with current monitoring methods) obtained with the innovative mix.”
What conclusions did you reach?
«This is a phase three trial (the last before the definitive approval of a new treatment) conducted within the European Myeloma Network, which involved multiple European centers and enrolled 302 patients. The results show that in 77% of patients who received the new mix (isatuximab-carfilzomib-lenalidomide-dexamethasone) pre- and post-transplant no tumor cells were found at bone marrow levels (negative minimal residual disease) approximately one year after the start of the treatment. therapy. Furthermore, effectiveness is maintained in different subgroups of patients, including those with more aggressive disease. The trial directly compares this four-drug regimen with a three-drug regimen (carfilzomib, lenalidomide and dexamethasone) already shown to be highly effective. The four-drug combination significantly increases the rate of minimal residual disease compared to the three-drug combination, without a significant increase in toxicities.”
Because it is important?
«It is an innovative regimen because it uses four drugs currently not yet approved for the treatment of patients with newly diagnosed multiple myeloma (but already used, with different combinations, in the treatment of patients with relapsed cancer). The study shows very promising data because it manages to achieve very high “minimal residual disease” rates, practically eliminating all cancerous cells, with well-tolerated side effects. Although it is too early to draw conclusions regarding the duration of remission and increased survival, achieving negative minimal residual disease is considered one of the strongest positive prognostic factors for patients.”
Corriere della Sera is also on Whatsapp. It's enough click here to subscribe to the channel and always be updated.
December 11, 2023 (modified December 11, 2023 | 07:56)
© ALL RIGHTS RESERVED
#Multiple #myeloma #progress #hope #recovery