The future of myeloma treatment
The development of new drugs to treat myeloma is being driven, to a large extent, by improvements in understanding the biology of myeloma. Although much has been learned in recent years about the biology of myeloma, many questions remain unanswered and research is key. As we understand more about how myeloma develops, drugs can be designed that are specifically targeted and therefore associated with reduced side effects.
Cancer vaccines are being investigated in myeloma as a way of creating a memory response and therefore ongoing immune surveillance. These aim to educate the patient’s immune system, particularly B and T cells to produce antibodies against myeloma specific antigens that will then recognise myeloma cells as foreign with longer term memory.
Natural Killer (NK) cells are from the same family as T and B cells but act slightly differently, responding quickly to pathological changes. In myeloma, they are being investigated both as an adoptive therapy (similar to CAR-T cell treatment) but also as a target for drugs that enhance their natural activity to kill myeloma cells.
Another avenue of research aims to increase our understanding of how and when smouldering myeloma develops into active myeloma, to determine if we can slow down progression and/or prevent severe end-stage organ damage. Some of the most promising clinical trial data comes from investigating the treatment of high-risk smouldering myeloma patients with lenalidomide-dexamethasone followed by lenalidomide maintenance, with results suggesting a delay in progression to active myeloma. Other anti-myeloma therapies are also being investigated in smouldering myeloma, but careful considerations must be made including adverse events and the effect on future treatments options and response if the disease has progressed.
Future treatment prospects are also fuelled by an increased understanding of how an individual’s genetic make-up influences response to treatment. The hope is that this will lead to truly personalised treatments for myeloma patients. Advancements in clinical trial design are required to create trials specific to certain patient groups to investigate this further. It is also important to understand how age, frailty and other comorbidities affect response to treatment so treatments can be better tailored. There is increasingly a move to improve clinical trial design to ensure they are more inclusive e.g. of age, stage of disease, race and gender.
As progress continues in the treatment of myeloma, nurses will continue to see improvements in overall survival but should be aware of the need not only to evaluate and manage the disease but also to be extra vigilant for inherent complications, side effects, and comorbidities.