Noopur Raje, MD: Multiple Myeloma Overview
Noopur Raje, MD is Associate Professor, Dept. of Medicine, Harvard Medical School and Director, Multiple Myeloma Program, Medical Oncology, Massachusetts General Hospital provides a basic overview of multiple myeloma.
The Group Room at the 2011 American Association For Cancer Research Annual Meeting was made possible, in part, by:
VIDEO TRANSCRIPT
Selma R. Schimmel, Founder & CEO, Vital Options International:
I’m Selma Schimmel at ASCO 2011 in Chicago, where we are bringing you news about new therapies and advances in the treatment of cancer. And now we’re going to talk about Multiple Myeloma and I’m joined by Dr. Noopur Raje, who is Associate Professor at the Department of Medicine at Harvard Medical School, and also the Director of Multiple Myeloma Program in the Division of Medical Oncology at Massachusetts General Hospital. Hello, Dr. Raje.
Noopur Raje, MD, Dir., Multiple Myeloma Program, Massachusetts General Hospital (MGH):
Hi, Selma. Thank you for having me.
Selma R. Schimmel:
I’m really happy to have you because there have been some important advances in the treatment of multiple myeloma and it’s one of these diseases that, I think, a lot of people don’t know about or maybe have never even heard of, it’s a painful cancer. Let’s go over, just a little bit about the biology of multiple myeloma, which, by the way, is your passion in academic medicine.
Noopur Raje:
Myeloma affects about, in the United States, about 20,000 people on a yearly basis, but what has happened, and as you pointed out, if left untreated it can be a fairly painful cancer. It’s a cancer which starts out in the bone marrow, it is a blood related cancer, a hematological cancer, and it starts out by plasma cells growing in the bone marrow, and these plasma cells tend to do several things and patients can present, if left untreated, with bad bone disease, can end up having infections and can end up having kidney problems, anemia, fatigue, and all of that. So if left untreated, certainly associated with a lot of morbidity.
Selma R. Schimmel:
How does the disease present? How would one have their first sense they need to go see their doctor?
Noopur Raje:
So, again, this is a disease which can present in… it’s a fairly heterogeneous disease, so there are some folks that will present acutely if they present with some of the complications I’ve just mentioned, which include kidney failure or bone problems if they end up with a bone fracture, but often times you see that it happens fairly insidiously so that patients are just kind of tired, not doing well. A lot of times it’s actually picked up by their primary care doctors when they do a blood test and find an abnormal protein in that blood test. So the way this presents is very, very variable and that may be part of the reason why sometimes it takes a long time to make the diagnosis of myeloma.
Selma R. Schimmel:
So the initial presentation isn’t with bone pain?
Noopur Raje:
Not always. There’s bone pain in about 50 or 60% of people at the outset. If you talk about skeletal related events – and when I say skeletal related events, we mean fractures – that’s seen in, I would say, about 20 or 30% of people at presentation.
Selma R. Schimmel:
Is there an age range that’s most typical, and also gender?
Noopur Raje:
So, typically it’s seen in people in their 60’s. You know, the notion has always been that myeloma is the disease of the older people. I will tell you that we do see young patients as well, and I think it may be more common in centers like our where we get a lot of referrals – so, for example, my youngest patient is in his 20’s – so it’s not as if you don’t see myeloma at that age, it’s just very uncommon. The common age group is 60’s and 70’s.
Selma R. Schimmel:
Is there a genetic predisposition?
Noopur Raje:
Well, that’s a question which is asked very often and the answer to that is, we typically do not do any genetic screening. If you look hard enough you will see some pockets where you have families with more myeloma in that population, but really there is no genetic predisposition. Once you get myeloma though, there are a certain set of genetic abnormalities, which are essentially prognostic factors so that we know that there are certain sets of genetic abnormalities which portend a slightly worse prognosis compared to others.
Selma R. Schimmel:
So, if one has a parent that has had multiple myeloma that doesn’t mean that you’re at greater risk for myeloma yourself?
Noopur Raje:
Correct. And we do not believe in… at least as of right now, we do not recommend any kind of screening for those folks.
Selma R. Schimmel:
So, let’s talk about treatment because when you look at the advances in treatment from a decade ago it’s pretty significant.
Noopur Raje:
It’s been very, it’s been great. It’s a nice ride in myeloma. We’ve been blessed. We’ve been very fortunate to have seen several new drugs being used in the treatment of myeloma and in our short lifetime. In the last 10 years, actually, we’ve seen about 5 new drug combinations, which have been approved. So really, unprecedented progress in terms of drug development, never been seen in any other cancer subtype, I would say. And it’s largely because of involvement of patients agreeing to go on to our clinical trials, it’s patient advocacy, academic institutions working together, working together with pharmaceuticals, but we’ve seen really a big difference.
I think, the more important end point here is yes, we have all of these new drugs, but has it impacted patient outcome and that is really the question. And the answer to that is, we’re seeing survivals improve. We’re seeing a definite improvement in our patients and our patients living with myeloma are living a lot longer than they did even 10 years ago.
Selma R. Schimmel:
And also, now the treatments are combination therapies, chemotherapies, targeted therapies and some agents that have been used for diseases that people would be surprised to hear about.
Noopur Raje:
Absolutely. So, you know we’re using… I think the focus is more on the so-called novel therapies. Novel therapies are no longer novel, we’ve been using them now for the last 10 years. It started out with the introduction of Thalidomide, as you just pointed out. We already have the next generation and the next generation of Thalidomide, which is Lenalidomide, which is the cousin of Thalidomide. And then you have the newest kid on the block, which is Pomalidomide. So we have those 3; and these are essentially pill forms.
So we’re kind of moving away from the old chemotherapy, which we used to use, which was, kind of, you know, attack all cells fairly toxic, but using some of these newer agents… another class of drugs, which has been very useful in the setting of myeloma has been protozoan inhibitors, and this includes drugs like Bortezomib or Velcade, and Velcade has really… first we used all of these drugs in the relapse setting, but now we’re actually using all of them in the upfront setting. So what we used, say 10 years ago, we no longer use. And you’re absolutely right, the focus now has been combination of all of these. So we are combining the immunomodulators with the protozoan inhibitors.
And what we’re seeing is actually 100% response rates in our patients, which is, again, unprecedented in myeloma. So it’s very reassuring to see that. And plus, we have a new pipeline of new drugs, which is part of what we, what I focus on in the lab as well. And, because even with what we have today, we’ve certainly impacted survival, we haven’t… we are still not in a position to say that we’ve cured myeloma, so there is a need to come up with newer and better drugs, even today.
Selma R. Schimmel:
So the hope that I take from my discussion with you is that more people are living with multiple myeloma, that the grim diagnosis and prognosis of some years back is much better and far more hopeful.
Noopur Raje:
It’s a completely changed disease; one is, patients are certainly living longer and they’re living longer better because some of the drugs we have now, Selma, not the old drugs we had which caused a lot of side effects – these drugs are not without side effects, absolutely have side effects – but if well managed, our patients can stay on these medicines for years, which I think is, again, a very important advance in the treatment.
Selma R. Schimmel:
Thank you, Dr. Noopur Raje, the Director of the Multiple Myeloma Program at Massachusetts General Hospital and Harvard Medical School.
Noopur Raje:
Thanks, Selma. It was great being here.
Selma R. Schimmel:
Thank you very much.
END OF VIDEO