Precision Oncology and the Cancer Moonshot: Where Do We Stand?

There have been recent commentaries on the prospects and potential for both what is called "precision oncology" and Vice President Joe Biden's Cancer Moonshot program. Although I have discussed both in the past, the current news, writes Dr. Vinay Prasad in the journal Nature, is quite “sobering.” The news is sobering because the hype and expectations are way beyond the truth. When costs are high—and in the case of precision oncology, they are extremely high—research efforts must focus on areas of likely success, not on high expense with little likelihood of return. Since myeloma is one of many cancers (and not the most common), we are particularly sensitive about the need to fully justify the spending of every research dollar.

Four Important Ways Iceland’s iStopMM Research Project Will Help Myeloma Patients Globally

The iStopMM research project is about to get started in Iceland. It is supported through the IMF’s Black Swan Research Initiative® and literally will include Screening, Treating OPreventing myeloma. Beginning in October 2016, approximately 140,000 people over 40 in Iceland will be screened with SPEP (serum protein electrophoresis), UPEP (urine protein electrophoresis), and Freelite tests to see if they have MGUS (monoclonal gammopathy of undetermined significance), smoldering multiple myeloma (SMM), or full-blown multiple myeloma (MM). If they have MGUS or SMM, they will be initially monitored. If they have myeloma, they will be treated.

Summer Updates: More about “dara” …and ideas about what may cause myeloma

In an important paper published recently in the journal Blood, researchers from the Netherlands and Belgium correlate the response to daratumumab (dara), the anti-CD38 monoclonal antibody, to the level of CD38 expression on the myeloma cells and whether or not complement inhibitory proteins (CIPs) CD55 and CD59 emerge with treatment. A separate report in Blood from a joint Danish, Netherlands, Italian, and US team summarizes the findings of a phase I/ II study combining dara with lenalidomide + dexamethasone to show that the combination produces responses in 81% of patients versus approximately 30% with dara alone. These results led to the development of the POLLUX trial, which recently confirmed the approximately 80% response rate for the combo with 78% of patients still in remission at close to 2 years. The results of the combination of dara with bortezomib (Velcade®) and dexamethasone (the CASTOR trial) were reported at ASCO in June this year and have just been published in the New England Journal of Medicine. In this case, the response rate was 82.9% but with shorter follow-up thus far. 

The new future for myeloma patients

As the dust settles from all the activity surrounding new drug approvals and the potential for further approvals, it is time to reflect on what the future holds for myeloma patients.

Darzalex® (daratumumab): more very good news and a caution

Janssen’s Darzalex®, or daratumumab, has been granted “Breakthrough Therapy” designation by the US Food and Drug Administration for use in combination with Revlimid® (lenalidomide) and dexamethasone, and Velcade® (bortezomib) and dexamethasone, for the treatment of multiple myeloma patients who have received at least one previous therapy. The designation was based on data from the CASTOR and POLLUX trials recently presented at ASCO 2016 and EHA 2016 respectively. The prolongation of remissions achieved by combining Darzalex with either Velcade/dex or Revlimid/dex were highlighted in my Myeloma Updates 2016 presentation, as well as recent blogs, “ASCO 2016: More excitement about daratumumab (Darzalex®), and tremendous interest in value and costs” and “Preview of the Black Swan Research Initiative’s First US Cure Trial.”

Pages