Noopur Raje, MD: Multiple Myeloma Research and Clinical Trials from ASCO 2011
Noopur Raje, MD is Associate Professor, Dept. of Medicine, Harvard Medical School and Director, Multiple Myeloma Program, Medical Oncology, Massachusetts General Hospital provides an overview of the multiple myeloma data coming out of ASCO 2011.
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 the Multiple Myeloma Program in the Division of Medical Oncology at Massachusetts General Hospital. Hello, Dr. Raje.
Noopur Raje, MD, Director, Multiple Myeloma Program, Massachusetts General Hospital (MGH):
Hi, Selma. Thank you for having me.
Selma R. Schimmel:
Well, let’s talk about your research and what’s going on in your own lab.
Noopur Raje:
So, as you pointed out, my lab focuses on myeloma research and it’s essentially two areas of research; one is novel therapeutics, and in terms of novel therapeutics there are several classes of drugs we work with. We work with CDK, cyclin-dependent kinase inhibitors, we’ve worked with mTOR inhibitors, and most recently we’re working on specific hdac inhibitors specifically attacking hdac-6. Another part of what we do in the lab is focus on bones. The majority of myeloma patients over their lifetime will end up having some kind of bone problem. It starts out in 60 or 70% of our patients, but as our folks are living longer you do see bone disease in a lot of patients. And what my lab is doing is focusing on trying to understand the biology of this bone disease in our patients and also actually, trying to target whether we can come up with newer novel ideas of how one can treat bone disease in people with myeloma.
Selma R. Schimmel:
People will understand when we say, like a monoclonal antibody, they’ve heard of that, these are very, these are complex research. How can we simplify now with some words to help, imagine the newly diagnosed patient listening to this interview, then wanting to go to their medical oncologist trying to take what you taught them to talk to their doctor.
Noopur Raje:
At this year’s ASCO there’s been a lot of focus on monoclonal antibodies, and what monoclonal antibodies essentially are one identifies a protein either in the blood or on the surface of your tumor cells and then produces an antibody to try and target that specific protein. We’ve had rituximab, which is a very well-known monoclonal antibody for the lymphomas for many, many, many years and I think, in myeloma we’ve been trying to look for rituximab for our patients because something like the lymphoma world, we’ve tried to identify different proteins, we’ve come up with some in the past, but if you look at this year’s ASCO abstracts we have 3, I think 3 presentations with monoclonal antibodies as part of therapy for myeloma. And essentially, each of these monoclonal antibodies is targeting a different protein or a different molecule on the surface of these tumor cells.
Selma R. Schimmel:
It seems that one of your compounds is also being evaluated as a potential treatment for rheumatoid arthritis.
Noopur Raje:
Absolutely. So, we’re presenting at this meeting a study where we’ve combined a monoclonal antibody directed against BAFF, which stands for b-cell activating factor. It’s, the compound is LY with a number, the number is not important because it still doesn’t have a name. And what we’ve done is combined this will velcade, or bortezomib, in our phase one study. And the reason we did this was, we’ve looked at myeloma patients prior to starting of the study and it’s about 60% of myeloma patients, if you look at blood levels of this B cell activating factor, it’s about 60% of myeloma patients have increased BAFF levels. We’ve gone on to study what BAFF does in myeloma patients and we, no one understands that BAFF comes from the micro environmental compartment, that is not the tumor, but the surrounding cells surrounding the tumor. And what it essentially does is it, circulating BAFF levels helps make myeloma cells survive, so obviously targeting that BAFF would be a good idea.
Selma R. Schimmel:
And what is the test used to measure these levels?
Noopur Raje:
So, it’s an ELISA test. It’s not yet commercially available. These are research tools as of right now but one can actually measure protein levels in the serum of patients. And this trial did not specifically look at patients who had high BAFF levels, we took all-comers, but part of our analysis would be to look at whether or not BAFF levels correlated with how their antibody worked.
Selma R. Schimmel:
You know, Raje, when I listen to you speak it seems to me that, unlike many other cancers, a patient that’s diagnosed with myeloma would likely benefit from getting evaluated at a cancer center, at an academic center, that the innovative therapies might not yet be available in private practice setting, and that many of the exciting compounds are really opportunities for patients to get involved in clinical trials
Noopur Raje:
You know, I think you bring up a great point, Selma. It’s very important… what’s going on with myeloma is there’s so much happening, which is a good thing, it’s a fantastic thing, we have a lot of options and not everybody out in the community is aware of these options. So not necessarily getting their care at a center which has all of these but at least getting the know-how and at least knowing what your options are out there.
Selma R. Schimmel:
Dr. Raje, the one thing that I’d like to talk a bit about is the issue of bone complications and the bone pain and treatments that are available and the research that’s such an important part of the disease.
Noopur Raje:
Absolutely. I mean, this is something which we focused on, as I pointed out earlier, this is part of what I do in the lab as well. Again, at this year’s ASCO, Selma, there are a couple of abstracts and this is data which was presented last year and it came out of the medical research council in the UK where they treated about 2,000 patients with a drug called zoledronic acid, which is an approved treatment for myeloma related bone problems and they compared it to an oral pill form of the same bisphosphonate called clodronate and what they found here was, not only was bone disease better in people who got this zoledronic acid, or Zometa, as it’s commonly called, but more importantly it actually impacted survival of our patients so that if you control bone disease there was a hint that patients live longer.
And the other important feature with this clinical trial was certainly the fact that whether you had bone disease or not at the outset, patients with myeloma benefited from being treated with a bone strengthening agent like zometa. So, critically important, everybody with myeloma should be on a bone strengthening agent. The other piece, which I think we’re focusing on now, all these years we focused on bisphosphonates and trying to restore bone health, we’re starting to look at another axis, which is bone formation and we have drugs specifically, like bortezomib, which is already being used, or velcade, which is being used for the treatment of myeloma, has actually pro-bone effects, it helps bone formation so it’s going to help strengthen bones even more.
Selma R. Schimmel:
And when you talk about strengthening bones I also think it probably strengthens the psychosocial component for the patient knowing that something is being done and the quality of life issue is just profound.
Noopur Raje:
Absolutely. These have impacted morbidity, mortality also, and quality of life. And the good news is we have drugs which now are going to enhance bone healing. Up until recently the teaching has always been, in myeloma bones done heal; once you have a hole in the bone, it’s not going to heal. But hopefully, in the next few years, we are actually going to see those holes heal with the drugs we have coming down the pikes. It is very encouraging data we have coming out of the lab.
Selma R. Schimmel:
It seems that myeloma is a disease that needs more attention, that the public needs to be better educated, and that I don’t know how much funding there is available for myeloma but I’m afraid that unless we raise the profile of this disease, not only does it impede research but it also increases terrible feelings of alienation and really alone feelings for patients and their families.
Noopur Raje:
Oh, absolutely. We’ve been fortunate with myeloma where we’ve had, like I pointed out earlier, good patient advocacy, we have good support systems like the International Myeloma Foundation, we have the Multiple Myeloma Research Foundation, who we work with closely, but at the same time, because it is a fairly uncommon disease the more attention it gets the better it’s going to be. And as you know, federal funding is really now on the down slide so anything we can do to get more research funding is always a good idea.
Selma R. Schimmel:
I hope that we’ll meet again, maybe next year with new data and a report on what’s going on in your lab.
Noopur Raje:
Absolutely, I look forward to it.
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. Thank you.
Selma R. Schimmel:
Thank you very much.
END OF VIDEO