Fighting Myeloma with the Measles?

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Topics include: Treatments

Is the measles is being used to treat myeloma?  Dr. Martha Lacy, a myeloma expert from the Mayo Clinic, explains how the measles virus is being used in clinical trials to treat multiple myeloma.  She describes the science behind how it works, the status of the trial, and why she’s hopeful about this new development.

Sponsored by the Patient Empowerment Network through educational grants from Onyx Pharmaceuticals and Takeda Oncology. 

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Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Dr. Lacy:

This is a new area of therapy that we're really excited about at Mayo Clinic.  One of our colleagues has genetically reengineered the measles virus.  So that instead of infecting normal cells, it infects myeloma cells.  And he also inserted the gene for iodine receptor, which means that many of the cells that get infected by the measles virus will express iodine receptors.  So we can, then, give trace doses of radioactive iodine, and it will get taken up in all of the measles-infected cells.

So we've done a Phase I trial, and then the early—early stages of the Phase I trial, we were seeing that the scans were showing that the measles scan was lighting up in all the same places that the PET-CT showed disease. But once we got to the highest dose level, we actually saw that translating into clinical responses.  And we've had a couple of very impressive clinical responses in that—in that Phase I trial.

Now, then, we had to shut the trial down until we could make more drugs.  And now the trial has just reopened as a—as a Phase II trial, and so the difference between a Phase I trial and a Phase II trial is what the Phase I trial, you start at real low doses.  You treat three patients.  Close the trial.  See them all come back.  Assess for side effects.  If nobody has bad side effects, you go up on the dose.  And you do that until you get the maximum tolerating dose.

We've, now, been through that.  The Phase II trial is you've got Drug X, and you want to know what percentage of people respond to it, and so that's where we are with the measles trial now.  The biggest impediment that we've seen so far is even though this trial was only open for myeloma patients who didn't have any other therapeutic options.  That actually is one of the eligibility criteria with it.  They could no longer be treated with all our standard drugs.

And even in that patient population with beat-up immune systems and rampant myeloma, about half of them produce antibodies against measles.  And if they have antibodies detectible in the blood, then they clear the virus so fast, it doesn't have a chance to infect and kill the myeloma cells but…

Jeff Folloder:     

So you're really giving measles to treat myeloma?

Dr. Lacy:                

We are.  We give about 10 times—10 to the 11th, whatever that is in…

Jeff Folloder:     

A lot.

Dr. Lacy:                

“…trajillions.”  We give a big whopping dose of measles virus, and it goes right to the myeloma cells and kills them. 

Jeff Folloder:     

Incredible.

Dr. Lacy:                

The lasting, we think that one of the lasting benefits of this might be that as those infected myeloma cells are dying, they are presenting the cancer to the immune system in a way that retrains the immune system to recognize it as foreign, because one of the problems with myeloma is your immune system tolerates it.  So we're hoping—that's why it's considered a vaccine, even though it's really actually a big infection.

Jeff Folloder:     

Dr. Burke, do you want to add something to that?

Dr. Burke:            

No, I was just—I was going to ask a question that she just answered, which is what is it that's actually killing the myeloma cells?  Is it the virus or is it the radioactive iodine?  And it sounds like it's the—the—the virus.  The iodine is just a tracer or…

Dr. Lacy:                

Right now, we've only used the iodine as a tracer for imaging purposes. But when it was designed, it was designed with the idea that once we know this is safe and effective, it could, in theory, act as a way to have a honing mechanism for a smart bomb.  So we could give therapeutic doses of radioactive iodine, and the radiation will go right to the cancer cells.

To get around the measles and the antibody problem, we, now, have reengineered a virus called VSV, which is vesicular stomatitis virus.  It normally only infects cows.  So there's no problem with all of the population's been vaccinated against it.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on March 24, 2015