Multiple Myeloma Expert Discusses Updates From ASCO 2019

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Topics include: Emerging Research

As part of our coverage of the 2019 American Society of Clinical Oncology (ASCO) conference in Chicago,Dr. Hearn Jay Cho joined Patient Power to give treatment research updates for smoldering myeloma. Dr. Cho shares findings from a clinical trial on early intervention in myeloma patients, and how this information will be used when making treatment decisions. Dr. Cho also discusses disease risk stratification in multiple myeloma and implications for therapy.

Click here to read more about the early intervention study specifically for smoldering myeloma. 

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Transcript

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.

Rebbeca Seago-Coyle:

Hey, everyone I'm here with Dr. Hearn Jay Cho from Mount Sinai, and he specializes in myeloma.  Dr. Cho, thank you so much for being here today.  This is a large conference here at ASCO, so why do you come to this conference?  

Dr. Cho:

Well, I think it's really important to stay abreast of not only my field but the breadth of cancer research, both clinical research and laboratory research.  So in my field I'm interested in immune therapies for multiple myeloma.  My laboratory studies new types of immune therapies, and I'm involved in clinical trials where we test new immune therapies in multiple myeloma.   

And immune therapies are broadly applied in cancer, so not only in the blood cancer field such as multiple myeloma, but there have been most of the advances in solid tumors, lung cancer, renal cell cancer, other types of solid tumors.  So it's important for us to stay current with new types of therapies, new types of clinical trials, novel combination therapies that are being explored in the solid tumor field and other types of cancers so that we can stay current with the state-of-the-art.   

Rebecca Seago-Coyle:

Great. Thank you so much for that.  And then is there anything, late?breaking news for myeloma patients that our community might want to know about?  

Dr. Cho:

There's two big areas of research in my opinion that were addressed in this year's myeloma sessions.  The first one is in the subject of smoldering myeloma.  So myeloma is divided into two types of patients, patients who have symptomatic disease who require treatment, and then there are patients who make the diagnostic criteria for multiple myeloma but don't have any symptoms.  And historically those patients are not treated. They're followed without treatment but followed very closely until they develop symptoms, because many of those patients will not develop symptomatic disease at all or not for many years.  So the standard of practice is not to expose those patients to the risks of chemotherapy if there's no benefit on their overall survival.  

So this year there was a new definition of so-called high-risk myeloma that was presented by Dr. Mateos, and there was a clinical trial of lenalidomide (Revlimid) as an early intervention for patients with smoldering myeloma based on the concept of not treating symptomatic disease but preventing progression into symptomatic disease.   

And I thought the presentations were very interesting, because we have been struggling to define who are the appropriate patients in that smoldering multiple myeloma bin who will benefit from therapy because if we appreciate that there are certain patients who are high?risk and other patients who are low?risk, then the low?risk patients we can clearly feel very comfortable about watching and not treating. Whereas the high?risk patients we may want to consider early intervention.  

And I don't, unfortunately, think that there was necessarily absolute clarity gained by these experiences, because my impression of the novel methods to classify is that we're still not perfectly able to predict who are the truly high-risk patients and who are not, and I think it's because there aren't discrete categories of patients with myeloma.  It's actually kind of a spectrum.  It's a continuum, and we're kind of arbitrarily drawing lines.  And if you really have a model that predict patients with super high?risk of progressing to multiple myeloma—symptomatic multiple myeloma, are those patients just myeloma patients?  There are symptomatic myeloma patients we just, for whatever reason, on the day that they got this test or that test it was just below the threshold, right?  

So I don't think that the new data or the new model really gains that much clarity.  It is an important addition, because what we are accumulating is the important clinical characteristics of each patients that contributes to their risk.  

Rebecca Seago-Coyle:

Right.  So how do you take this back to your clinic and to your lab, this information, and even work with your patients?  

Dr. Cho:

So it helps us understand what the playing field is when, for example, we meet a smoldering myeloma patient how we would recommend management, whether we would stick with the conventional standard of care, which is watch and wait, whether we might refer that patient for a clinical trial. Because we think that they are high?risk and how to frankly discuss these factors with our patients, because ultimately we need to empower our patients to make good decisions regarding their own care. And we partner with our patients and we are advocates for our patients, but it's important for us to be as informed as possible and to be able to identify our knowledge deficits when patients ask questions.  So we need to be as well informed as possible and also forthright in what we don't know.  

And from the laboratory perspective I think it points to a real need to understand the biology of the disease better.  So in our laboratory studies in correlative studies for clinical trials and in the design of clinical trials, we need to use the science to understand the biology of these, particularly with immune therapies.  Because this is a different type of biology than, for example, targeted therapies or conventional chemotherapy.  And so understanding how those fit in with the normal and abnormal interactions that myeloma cells have with their microenvironment is very important to carry these discoveries forward to more effective therapy.  

Rebecca Seago-Coyle:

Great.  All right.  Is there anything else that you would like to share with our myeloma community? 

Dr. Cho:

Well, I would like to advocate for clinical trials and thank all the patients out there who participate in them, because that's how we're pushing the field forward. 

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 August 20, 2019