Multiple myeloma treatment advances: What health execs should know

Multiple myeloma is a rare cancer, representing about 1.8% of all cancers combined, according to the National Cancer Institute. About 30,000 new cases are expected in the U.S. in 2017. It is more common in men than women, among individuals of African-American descent, and those aged 65 years and older. The SEER Cancer Statistics Review, a report of the most recent cancer incidence, mortality, survival, prevalence, and lifetime risk statistics published annually by the Surveillance Research Program of the National Cancer Institute, notes that the five-year survival rate of myeloma is 49.6%.

It has been an exciting time at the Myeloma Institute at the University of Arkansas for Medical Sciences (UAMS), in Little Rock, Arkansas, on all fronts, namely, embarking on research that could play an important role in the development of preventative and curative strategies for multiple myeloma in the future.

“We continue to see a large number of patients with multiple myeloma and other plasma cell disorders from across the United States and the world,” says Gareth Morgan, MD, a physician and director of the Myeloma Institute. “Our research investigations have led to some exciting discoveries in the biology of myeloma based on the genetic variations within the human genome. With our colleagues in Europe, we have identified eight new genetic variations that could be linked to an increased risk of developing myeloma.”

UAMS is focused on developing a molecular classification of patient subgroups with distinct pathogenesis and clinical behavior. It partnered with Celgene and the Dana–Farber Cancer Institute in establishing a global collaboration called the Myeloma Genome Project.

“The goal of this project is to compile and analyze the largest set of genomic and clinical data to design a molecular classification system to improve the diagnosis, prognosis and treatment of myeloma,” Morgan says. “This initiative could really lead the way in developing targeted treatments for patients in the future.”

Morgan recently spoke with Managed Healthcare Executive (MHE) about other promising developments in the multiple myeloma field, as well as the challenges and ways to overcome them.

MHE: What are healthcare executives’ major challenges in the area of multiple myeloma?

MorganMorgan: Uncertainty about the future of healthcare policy and payer coverage is clearly one of the biggest challenges faced by leaders across the industry. We know that patients diagnosed with a complex cancer like myeloma fare better when they are treated by a specialist at an experienced facility like the UAMS Myeloma Institute, when compared to oncologists in community-practice settings for whom myeloma may only represent a small portion of their patient population.  Unfortunately, some patients don’t have access to specialized myeloma programs because of insurance or other financial restrictions. This is something we see every day.

The personal and economic burden of a cancer diagnosis like myeloma really heightens the urgency for more research, but decreases in federal and state funding have made it more difficult.

Next: How can these challenges be avoided?

MHE: How can these challenges be met or avoided?

Morgan: Maintaining the quality of clinical care and sustaining our research program are our highest priorities. We are not implementing cost reduction strategies but rather are discovering more effective ways to improve outcomes by addressing variations in practice and optimizing resources through a service-line approach. We are also expanding our collaborations with university and industry partners to develop new clinical trials to answer strategic questions related to high-risk disease. We are also working on improving the myeloma clinical guidelines through the International Myeloma Working Group.   

MHE: What are promising developments in multiple myeloma?

Morgan: The increased understanding of the genetics and epigenetics involved in the initiation and development of myeloma cells has really powered the concept of precision medicine, such as the development of targeted therapies directed at specific mutations at the molecular level.

Immunotherapy represents another promising treatment approach for patients.  Addressing relapsed disease via resistant clones has led to the development of new immune-based strategies, some which are already approved and providing results and others which are in development.

An exciting advancement on the horizon is the development of a peripheral blood biopsy as an alternative to bone marrow aspirate and biopsy, which not only would be more comfortable and convenient for patients, but may also offer a more comprehensive profile of myeloma cells, which could be of particular use in the earlier stages of the disease, such as in pMonoclonal gammopathy of undetermined significance]  and smoldering myeloma.