Inching Toward a Cure for Multiple Myeloma

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.

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Measles vaccine attacks cancer in landmark study (MULTIPLE MYELOMA)

ROCHESTER, Minn. - Mayo Clinic researchers announced a landmark study where a massive dose of the measles vaccine, enough to inoculate ten million people, wiped out a Minnesota woman's incurable blood cancer.

The Mayo Clinic conducted the clinical trial last year using virotherapy. The method discovered the measles virus wiped out multiple myeloma cancer calls. Researchers engineered the measles virus (MV-NIS) in a single intravenous dose, making it selectively toxic to cancer cells.

Stacy Erholtz, 49, of Pequot Lakes, was one of two patients in the study who received the dose last year, and after ten years with multiple myeloma has been clear of the disease for over six months.

"My mindset was I didn't have any other options available, so why wouldn't I do it? I had to have failed all conventional treatment to do that trial. That actually happened last March," said Erholtz to KARE. "It was the easiest treatment by far with very few side effects. I hope it's the future of treating cancer infusion."

Dr. Steven Russell, a Mayo Clinic hematologist, spearheaded the study and said the concept was previously tested in mice, but never in humans until now.
"It's a huge milestone in that regard," said Russell. "We have known for some time viruses act like a vaccine. If you inject a virus into a tumor you can provoke the immune system to destroy that cancer and other cancers. This is different, it puts the virus into bloodstream, it infects and destroys the cancer, debulks it, and then the immune system can come and mop up the residue."

Two multiple myeloma patients were chosen because they are immune-compromised, and can't fight off the measles before it has time to attack cancer. Both had limited previous exposure to measles, and therefore fewer antibodies to the virus, and essentially had no remaining treatment options. Of the two subjects in the study, Stacy was the only to reach full remission. The other patient's cancer returned after nine months.

Dr. Russell believes it's still a medical milestone, and he hopes his team can one day transform this research into a single shot cure.

"It's like a call to action. It's not just good for our virus. It's good for every virus everybody's developing as a cancer therapy. We know this can happen," said Dr. Russell.

Mayo researchers are also testing the measles virus's effectiveness at fighting ovarian, brain, head and neck cancers and mesothelioma. They are also developing other viruses that seem to have potential to kill cancer cells.

"I think it's just remarkable. Who would have thought?" said Erholtz, who said she returns to the Mayo in June for a check up.

The Mayo is moving immediately into a phase two clinical trial involving more patients with a goal of FDA approval within four years.

Patients interested in the upcoming clinic trial using measles vaccines to treat cancer can inquire here.

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New study presents promising results for treatment of multiple myeloma

A new study conducted by scientists from the Dana-Farber Cancer Institute at Harvard Medical School, USA, and Karolinska Institutet, Sweden, presents very promising results for the treatment of the cancer form multiple myeloma. The drug candidate used in the research has been developed by scientists from Karolinska Institutet and a Swedish company following its initial identification at the same university. The findings are so promising that the scientists are teaming up with Harvard to bring the drug to clinical trials on patients.

The journal Blood has published a new study on a drug candidate for multiple myeloma, a form of cancer that affects about one per cent of all tumour patients, with some 600 people a year developing the disease in Sweden. Multiple myeloma is a life-threatening disease and there is a dire medical need for new therapies, especially for the patients whose tumour cells have become resistant to the conventional drugs.

"The discovery that our substance works on multiple myeloma cells resistant to conventional therapy is very promising for the future," says Professor Stig Linder at Karolinska Institutet's Department of Oncology-Pathology. "We're now very hopeful that we and our colleagues at Harvard Medical School will be able to develop an effective treatment."

The study demonstrates that the drug candidate, called VLX1570, inhibits tumour growth and prolongs survival in preclinical multiple myeloma models. The exact mechanism of action of the substance was identified earlier at Karolinska Institutet (Nature Medicine, 2011); put simply, the tumour cells can be said to be more sensitive than normal cells to disruption to the machinery that breaks down defective proteins. When this machinery is blocked, it triggers apoptosis (programmed cell death) in the tumour cells.

"We show that the drug candidate kills multiple myeloma cells from cancer patients," says Professor Linder. "The substance is also effective against myeloma cells that have developed a resistance to the clinically used drug bortezomib."

Dr Dharminder Chauhan at Harvard Medical School says that the mechanism of action is very interesting as regards the development of new cancer drugs and adds, "We're delighted to be able to study the therapeutic potential of this new drug candidate in clinical studies. We hope that the joint research we're doing will lead to improved cancer treatments."

The study also found that the new substance could be combined synergistically with other cancer therapies. Karolinska Institutet and Harvard Medical School are due to launch a large-scale clinical study next year in association with drug discovery company Vivolux AB (Uppsala, Sweden).

"If the study proves successful it will represent a great step forward, mainly for all cancer patients but also for the Swedish drug industry," says Professor Linder.

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POSSIBLE TREATMENT FOR SERIOUS BLOOD CANCER MULTIPLE MYELOMA

A cure for the confounding condition multiple myeloma may have been found.

A single antibody could be the key to treating multiple myeloma, or cancer of the blood, currently without cure or long-term treatment.

“We tested the antibody in various ways, including on tumour cells from myeloma patients that have been transplanted into mice. The tests showed that the antibody is able to destroy myeloma cells”, explains Markus Hansson, a researcher at Lund University in Sweden.

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