HemOnc Today's PharmAnalysis

HemOnc Today's PharmAnalysis

June 29, 2018
3 min read
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Stand Up To Cancer dream team strives to revolutionize myeloma treatment

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Irene Ghobrial

Stand Up To Cancer awarded a $10 million grant to a research “dream team” that will strive to revolutionize the treatment of multiple myeloma through early detection of precursor conditions.

“We tell people with precursor conditions that we will ‘watch and wait’ until it turns into multiple myeloma, with multiple tumors that can potentially cause organ damage,” Irene Ghobrial, MD, associate professor of medicine at Dana-Farber Cancer Institute, said in a press release. “That is like telling people with breast cancer or colon cancer that we are not going to do anything until the cancer metastasizes throughout the body. We want to change that.”

A multiple myeloma “dream team” will be entirely devoted to research for hematologic malignancies. The work will be led by Ghobrial and co-led by Ivan M. Borrello, MD, associate professor of oncology at Johns Hopkins University School of Medicine.

Projects will include the first-ever large-scale U.S. population survey for precursor conditions of multiple myeloma, specifically monoclonal gammopathy of undetermined significance (MGUS) or smoldering multiple myeloma. The team also will work to develop new treatments for high-risk smoldering multiple myeloma and multiple myeloma.

HemOnc Today spoke with Ghobrial about this Stand Up To Cancer initiative, what it is designed to accomplish and how the dream team’s findings may guide patient care.

 

Question: Can you provide an overview of this i nitiative?

Answer: We will screen 50,000 individuals who are at high risk for multiple myeloma. We will look for precursor conditions — MGUS and smoldering myeloma — and we will track those who have it by blood sample. We expect that approximately 3,000 people will have precursor conditions. We will follow them to assess the causes for progression to myeloma and whether we can develop therapies to prevent this. In certain cancers, we do not always look for patients to have a precursor condition. For other cancers, we have screening tools, such as mammography for breast cancer or PSA testing for prostate cancer. Early detection means we can prevent further progression and cure the disease earlier. For multiple myeloma, we have precursor conditions known as MGUS or smoldering myeloma. Three percent of the population aged older than 50 years has these precursor conditions. Prevalence is three times higher among the black population and three times higher among those who have a first-degree relative with multiple myeloma.

 

Q: Why are myeloma precursor conditions important to study?

A: People with these conditions are more likely to develop multiple myeloma. Yet, we do not look for the conditions. Even when we do diagnosis MGUS, we find that most just ‘watch and wait’ and do nothing. This is one of the reasons why we are aiming for early detection and prevention.

 

Q: Why is it so challenging to determine which patients with these precursor conditions will develop myeloma?

A: There has not been a true screening study conducted, and there are multiple reasons. First, to get 50,000 individuals to participate is difficult. Another challenge is that much of the black population is weary about clinical trials, so overcoming this is a challenge. Following all of these patients and trying to organize the data has been a challenge, as well.

 

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Q: How will the clinical trial be conducted?

A: We wanted to be aggressive in our timeline for accrual, which is set at 1.5 years. We are recruiting online and using social media and foundations to reach out to people across the nation. There is a huge infrastructure being built to incorporate all of this, and it includes so many people working to make this happen.

 

Q: What are the potential implications of the findings?

A: First, we could potentially change the way we screen people. Instead of a mammogram or colonoscopy at the age of 40 or 45 years, we would use a blood test to look for blood cancers — many of which are curable, so early detection could make a significant difference. Second, we are completely changing the way we think of myeloma. Rather than waiting to treat a patient until the precursor condition [transforms into myeloma] or organ damage occurs, we will treat early and potentially prevent myeloma from happening, or at least delay it from happening.

 

Q: Is there anything else that you would like to mention?

A: We believe this work could potentially change not only multiple myeloma but many other cancers that have precursor conditions. We will additionally be looking at the prevention of other hematologic cancers with the blood samples we obtain. This could lead to collaborations with others who are interested in using these blood samples for other research. – by Jennifer Southall

 

For more information:

Irene Ghobrial , MD, can be reached at Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215; email: irene_ghobrial@dfci.harvard.edu.

Disclosure: Ghobrial reports no relevant financial disclosures.