With new treatments transforming multiple myeloma into a chronic condition and additional therapies on the horizon, some experts believe a cure is within view.
Dana Davis, a 56-year-old school administrator in suburban Atlanta, remembers the rib pain first.
“I had an excuse for everything,” Davis says with a laugh. “But finally, my wife said I couldn’t ignore it any longer. She insisted that I go to the doctor. Pretty quickly, they found that I had anemia. Then they diagnosed multiple myeloma.”
That was 15 years ago. Davis has already survived three times longer than patients with even the best prognosis could have expected in the 20th century. The father of a son and two daughters when he was diagnosed, he has been able to watch those children grow up, take in a foster son, who is now 11, and see his first grandchild born.
And Davis is now part of a clinical trial of a targeted monoclonal antibody, daratumumab, that researchers hope will be a game changer in the treatment of myeloma. Even more amazing, Davis’ story is becoming more and more common.
A multiple myeloma diagnosis used to mean that a patient could only expect to survive three to five years — with only chemotherapy agents available for treatment. Today, that landscape has changed so much that it’s almost unrecognizable, with average survival nearly tripled and additional advances on the horizon with a sophisticated array of therapeutic options.
Doctors are trying established drugs in new combinations, doses and formulations that seem to cut down on the side effects of treatment, and also to lengthen stretches of progression-free survival (PFS). Some drugs in the clinical trial pipeline enlist the body’s own immune system to fight the disease, while others target cells with specific genetic mutations, or never-before-targeted systems that control cell processes. The fact that oral drugs are in development means that patients don’t have to travel to an infusion center every few weeks to keep their cancer under control.
Multiple myeloma remains an incurable disease, but it is becoming more manageable. Doctors are beginning to talk of it as a “chronic disease.” Some are optimistic enough to even say that a cure may be possible.
“It’s a massive convergence of our understanding of biology, the technology becoming available to understand myeloma cells and how they respond, the genetic subtypes of myeloma, the ability to engage both the patient community and researcher, to transfer data and information,” says Walter Capone, president and CEO of the Multiple Myeloma Research Foundation. “It’s truly a renaissance in our ability to make treatment of myeloma more precise and accelerate breakthroughs for patients.”
Approximately 22,000 Americans receive a multiple myeloma diagnosis each year. Myeloma is the second most common blood cancer, after lymphoma. It tends to strike African-Americans more often, and those older than 65.
Myeloma starts in the plasma cells of the bone marrow, white blood cells that, when healthy, are specialized immune cells, specifically B-cell lymphocytes that make antibodies. As the myeloma kindles, the plasma cells stop doing what they’re supposed to do and start making large amounts of an abnormal, non-functional antibody called “M protein.” These proteins and cells can clump together, forming hole-like cysts in the bone. If more than one cyst has formed, the diagnosis is “multiple” myeloma. M proteins and other substances made by myeloma cells also can etch away bone tissue, causing pain and breaks. They may thicken the blood, interfering with the normal function of kidneys, bone marrow, nerves and the immune system. And they can lead to high levels of blood calcium, causing dehydration and kidney problems or failure, or make patients susceptible to infection.
Myeloma is expensive. The incidence of lung cancer is 11 times greater than the incidence of multiple myeloma, but the annual costs associated with multiple myeloma are $100-plus million more than the costs associated with patients with lung cancer that has spread to the bones. The costs of the new drugs for a single patient range from $98,000 to $276,000 per year.
From Standard Treatment to New Territory
In recent years, the standard treatment has been a course of traditional, high-dose chemotherapy drugs like melphalan or cyclophosphamide, considered an “induction” phase of treatment meant to induce remission of the cancer prior to a stem cell transplant. Next, the patient receives a stem cell transplant. This grueling, months-long procedure replaces the diseased bone marrow with healthy marrow from a donor. The side effects of myeloma treatment can be harrowing: drops in blood counts, crushing fatigue, diarrhea, severe bone pain, relentless infections, nausea, heart damage.