Advances in Multiple Myeloma Treatment: Path to a Curable Disease

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• Current State of Cure in Multiple Myeloma
• Defining What Cancer Cure Means
• Future Treatment Landscape and Goals
• CAR T-Cell Therapy as Standard Care
• Patient Quality of Life and Long-Term Management
• Full Transcript

Current State of Cure in Multiple Myeloma

Dr. Nikhil Munshi, MD, states that multiple myeloma is already being cured in a significant proportion of patients today. He explains that approximately 15% or more of patients treated a decade ago have not relapsed. These patients received state-of-the-art treatments available at that time. Modern treatments are even more effective, potentially increasing cure rates.

Dr. Nikhil Munshi, MD, notes that clinicians remain cautious about using the term "cured" due to historical cases of late relapses after 10-15 years. This caution stems from the need for longer follow-up data to confidently declare a patient cured.

Defining What Cancer Cure Means

Dr. Nikhil Munshi, MD, provides a practical definition of cancer cure. He describes two potential scenarios for considering a patient cured. The first scenario involves complete disease eradication with no need for ongoing treatment. The second scenario involves long-term maintenance therapy that keeps the cancer from returning.

Dr. Munshi compares this approach to managing chronic conditions like diabetes or hypertension. He emphasizes that if patients can live normally with simple maintenance treatment, the practical outcome is similar to cure. This perspective helps patients understand their long-term prognosis better.

Future Treatment Landscape and Goals

The future of multiple myeloma treatment focuses on identifying which patients achieve durable remission. Dr. Nikhil Munshi, MD, explains that researchers need more data to pinpoint which treatments provide long-term cure. The goal is to build on current success rates and increase the number of patients who never relapse.

Dr. Munshi expresses hope that within the next few years, sufficient data will emerge to officially declare certain patient groups cured. This would allow patients to return to living their lives without cancer concerns. The interview with Dr. Anton Titov, MD, highlights these exciting developments in myeloma research.

CAR T-Cell Therapy as Standard Care

CAR T-cell therapy represents a major advancement in multiple myeloma treatment. Dr. Nikhil Munshi, MD, confirms that this immunotherapy will become standard care for most patients. He notes that CAR T-cell therapy is already being used safely in patients up to 80 years old.

While not suitable for every patient, particularly those over 80, CAR T-cell therapy will benefit the majority of myeloma patients. Dr. Munshi's experience includes treating numerous patients successfully with this approach. The therapy's scope continues to expand as techniques improve and experience grows.

Patient Quality of Life and Long-Term Management

The ultimate goal of multiple myeloma treatment is enabling patients to live healthy lives without cancer concerns. Dr. Nikhil Munshi, MD, emphasizes that cured patients should focus on general health maintenance rather than cancer worry. They can concentrate on heart health, lung function, and other age-appropriate health considerations.

Dr. Munshi's approach during his discussion with Dr. Anton Titov, MD, focuses on practical outcomes for patients. Whether through complete eradication or successful maintenance therapy, patients achieve freedom from cancer-related mortality. This shift in perspective represents a significant advancement in how we view cancer treatment success.

Full Transcript

Dr. Anton Titov, MD: Professor Munshi, you are a pioneering researcher in multiple myeloma and blood cancers as a clinician. What is the future in multiple myeloma treatment? When will multiple myeloma be a reliably curable disease?

Dr. Nikhil Munshi, MD: I would say we are curing myeloma today, but we are afraid to say that because we feel we need a little more follow-up. If I expand on it, I think there are proportional patients. We all have patients who were followed for more than the last eight or ten years, where myeloma disappeared and has not come back.

The question is, when would I call that patient a "cured patient"? We don't call it yet. The reason is, in the old days, we all had patients who relapsed after ten, twelve, and fifteen years. So we feel we cannot call it a cure yet. What if the patient relapses after a certain time?

There are a proportion of patients, I will say fifteen percent or a little higher, who have not relapsed for a long period of time. In many cases, we would call that a cure, but we are not yet doing that. So I think that's the state. These are the patients who got treated ten years ago with the treatment which was state-of-the-art then.

Today, we have much better treatment, and so we might be affecting more patients. My hope is that in the next few years, we will have enough data to begin to say which patients are not relapsing or are not going to relapse, and what treatments are providing that.

Then we can build on this to increase the number of patients who are not going to relapse, and they will be officially declared cured. They can go back to living their life.

Now, cure has many meanings. What does cure mean? It means you're done with the treatment; everything is gone. We're not taking anything—that's one way. Or, number two, patients might be taking maintenance treatment; the myeloma is not coming back, and the disease is fine.

So converting a disease into a state which is more like, say, diabetes. But can we cure diabetes? The answer is no, but we can treat it very successfully for the next seventy years. So if cancer becomes like that, what is the difference? It should not be a difference.

I ask my patients, "Why would you worry if you can take one pill for the rest of your life and the cancer doesn't come back?" That's kind of reassuring when you compare it with a situation like diabetes or hypertension.

So it could be the disease is gone, or it's a situation where it's not going to come back and we take just maintenance treatment for a long period. Either way, the patient would not die from myeloma. They would be worried about other diseases, taking care of their heart, lungs, and other things, and be living a healthy life—not worrying as much about myeloma and dying from it.

One should also think that CAR T-cell therapy and other immunotherapies would be the standard of care for all patients in the coming future. Absolutely, I think it's going to be standard of care for a very large number of patients. "All patients" is a strong word because, at a certain age beyond eighty, its utility would be a little bit less.

But up to the age of eighty, we do CAR T-cell therapy right now. We have done more than a few patients safely. So I think the scope has expanded to include the majority of patients, and it will become a standard for all those patients. A small minority, we may have to be careful how we use it and when we use it.