Video information:
On location at the recent 2017 American Society of Clinical Oncology meeting (ASCO), Dr. Hearn Jay Cho of Mount Sinai Hospital discusses news out of ASCO 2017 and what it means for myeloma patients and care partners. Dr. Cho highlights news out of the meeting, including how experts are manipulating the immune system, precision medicine efforts in myeloma targeting specific mutations and adoptive therapies in myeloma.
Transcript:
Andrew Schorr:
Hello. I'm Andrew Schorr from Patient Power on location at the American Society of Clinical Oncology meeting where a lot of news breaks in all different cancers. We wanted to get an update from leading specialists in multiple myeloma, so joining us is Dr. Hearn Jay Cho, who is a specialist in myeloma at the—I want to get it right.
Dr. Cho:
Tisch Cancer Institute at the Icahn School of Medicine at Mount Sinai in New York.
Andrew Schorr:
Okay. New York City, okay. Well, you're presenting research here.
Dr. Cho:
That's correct.
Andrew Schorr:
And also there's the evolution for myeloma patients. Thank God we have people living longer, many people, so tell us a little bit about the research, tell us about how you think things are improving for patients with multiple myeloma.
Dr. Cho:
Well, the novel therapies that were introduced in the last 15 years have definitely improved overall survival. Patients are living a lot longer, but we still have work to do. And the area that's of greatest interest right now is immunologic therapies. That happens to be my specialty, and that encompasses a fairly broad range of strategies, targeting monoclonal antibodies such as elotuzumab (Empliciti) and daratumumab (Darzalex), immune checkpoint inhibitors that target CTLA-4 and the PD-1, PD-L1 access, and also cell-based therapies such as CAR T cells, T-cell receptor transgenic T cells, and then engineered antibodies or T-cell activators as they're called.
Andrew Schorr:
All right. Let me just stop you for one second because not everybody understands that. Some patients have been living with myeloma a long time and learn the science. But for those who don't, you have some things that target the cells, the aberrant cells, the cancer cells, and then you have this sort of environmental immune system medicines you're looking at and combining them, right?
Dr. Cho:
So at a very broad level immunologic therapies are designed to mobilize the patient's own immune system against the tumor cells, in this case myeloma. And there are two very broad classes. One is what's called active immunotherapy so things like vaccines or checkpoint inhibitors which unleash the immune system allows the immune system to find what it likes to kill in the tumor cells, and it should provide long-lasting immunity.
Then there are so-called adoptive therapies such as monoclonal antibodies that target the tumor cells in particular. It's not clear whether cell-based therapies are long-lasting or short-acting, but that is an area of great interest and research right now.
But the overall theme is that unlike chemotherapy where essentially a toxin is designed to kill the tumor cells directly, instead we are manipulating the immune system to identify tumor cells and kill them through natural mechanisms.
Andrew Schorr:
Okay. Now, increasingly at some of the centers and maybe yours too, you're looking at the genes that have gone awry in one particular patient's, an individual's myeloma, and that may relate to more personalized or precision medicine.
Dr. Cho:
That's correct. So there's a number of different research efforts to target specific mutations or abnormally expressed genes in myeloma patients. That's more into the chemotherapy, a targeted therapy type of realm, but there's been significant progress in that area identifying common mutations that are, activating in tumor cells and identifying chemotherapy agents some of which may be approved for other types of cancer which can be used to target those mutations in myeloma.
Andrew Schorr:
Okay. So if for instance there a may be a breast cancer drug or a drug for bladder cancer or something else that may have a genetic similarity to what you have or the identical gene, and maybe that medicine would work.
Dr. Cho:
That's correct. So one example is in melanoma, or skin cancer, there are common mutations in a pathway for a gene called ras, and there happens to be a drug that's approved in a melanoma called trametinib, or Mekinist, which inhibits an enzyme in the Ras pathway. And there's a number of research efforts now looking at Ras mutations in myeloma patients and seeing if we can use trametinib or related drugs, and we've seen some evidence of response. It's a little too early to report how generally applicable that experience is, but we definitely have patients who respond to these types of drugs that are targeting specific mutations.
Andrew Schorr:
And you're also looking at medicines that can go before or after transplant, right, and what helps people?
Dr. Cho:
So that's an area of interest for the immunologic therapies such as myself. In many ways, autologous stem cell transplantation is the ideal point to apply immunologic therapy, because these are patients who are not necessarily going to be getting a lot of heavy chemotherapy before or after the transplant, so their immune system is relatively healthy. It's the minimal amount of disease that they're ever going to have. So if you can get the immune system to get in there and mop up the residual disease, that's our best opportunity.
There are some challenges, because, of course, there is high-dose chemotherapy associated with stem cell transplantation. One of the findings of our previous studies was that you can take healthy white blood cells from patients before they undergo the stem cell transplant. And if you just give those cells back after you give back the stem cells, you can restore immune response in this to things like vaccines, for example.
And a number of centers have done variations on this type of strategy. The net result is that we can create a fertile ground for immunologic therapies even after high-dose chemotherapy and autologous stem cell rescue.
Andrew Schorr:
Wow. So last year we had a whole bunch of new drugs, approvals for myeloma. Your center and others are combining them in a number of ways, and now you're adding this kind of new science that you're looking at. So what do you want to say to patients, families affected by myeloma now about a positive momentum in myeloma to help people live longer and hopefully live better?
Dr. Cho:
Well, the positive momentum in myeloma has been going on for 10 years. I started in this field in the early 2000s, and we were facing very short overall survival and very limited number of drugs. And the last 15 or 16 years we have had proteasome inhibitors, immunomodulatory drugs, and now there's the next-generation, targeted antibodies such as elotuzumab, daratumumab. They're revolutionizing our field, so I have a lot of optimism for the future.
We haven't cured the disease yet, but patients are living a lot longer. So I think that if there are opportunities for patients to participate in clinical trials of new agents or new combinations of agents, I would certainly encourage them to do so and collaborate with their physicians to identify their best opportunities.
Andrew Schorr:
Dr. Hearn Jay Cho from Mount Sinai and your long titles for institution there, thank you so much for joining us from New York City.
Dr. Cho:
Thank you. It's my pleasure.
Andrew Schorr:
I just want to make one comment. You hear about the pace of change going on, I'm sure you'd agree. So he mentioned about clinical trials. So all these medicines we've had for multiple myeloma are with the help and partnership of patients who participated in clinical trials, and this pace is quickening. So please talk to your doctor about whether there may be opportunities in trials that might give you, plugged into science he's working on, the opportunities for tomorrow's medicine today.
In Chicago at the ASCO, big medical meeting, I'm Andrew Schorr. Remember, knowledge can be the best medicine of all.
