Past, Present and Future of Multiple Myeloma: How Genomics Will Play a Role

On top of the 10 agents approved to treat multiple myeloma over the last 10 years, patients’ options are not ending there, especially with the role of genomics coming into play, according to Chris Williams.

“The mission of the (Multiple Myeloma Research Foundation [MMRF]) is to engage every patient and to give them precisely what they need for the cure of their disease,” Williams, who is vice president of business development at the organization, said in an interview with CURE. “…We track the genetics behind each patient’s disease and try to match them with the appropriate therapy given for that genetic background.”

With this, Williams went on to discuss how the treatment landscape has changes over the last 20 years, and moving forward, how genomics and genetics will play a major role in multiple myeloma.

CURE: Looking back, how far have we come and where are we headed in the myeloma space?

Williams: We have come quite a long way. What has transpired in the last 10 years in myeloma has been incredible actually. The MMRF was founded in 1998 and in those 20-plus years, there has been 10 new drug approvals. At the time the MMRF was founded, there was the same drug treatments used in the 50s and 60s, so it has been an incredible growth for myeloma drugs which have benefitted patients greatly. The amount of choices patients have now and the options they have through their journey is just incredible.

Overlaying that with precision medicine and looking at genetics and their DNA and what makes up people’s disease is another next new step for options that patients can have. Now, we’re not just giving a drug because they have a disease, we’re giving them a drug because they have a disease with this specific genetic subtype that is much more precise and possibly more effective for them. So, that has been where we are up to this time.

What is coming in the future is this onslaught and same type of evolution that genetics caused in the mid-2000s with the immune space. So, we are looking at drugs like CAR-Ts and antibodies that will give us more options, not just treating patients on the genomic side, but also their immune side. I believe that the overall disease is going to be best treated when the genomics and the immune space can be targeted with drugs precisely for a patient. I think what is to come is a great wave of immuno-oncology drugs in the myeloma space that is going to be done.

Are there any new initiatives the MMRF is working on?

One of the new initiatives that we are also taking on in the coming years is what we call Immune Atlas. We are looking at retrospective patient samples that we have stored away in our biobank and we are looking at those with multiple different assays and multiple different organizations that run these assays or tests on these samples and trying to what we call harmonize the ways we look at the immune repertoire of myeloma patients. At the end of the day, what we would really like to have is a set of assays that we can confidently say these are the tests that need to be run on these blood samples to get the immune profile reliably of myeloma patients. Right now there are many tests, and they are good tests, but they are run in different ways with different reagents and we would really like to harmonize those so that as the tests are run we get the same results across the whole population of myeloma patients and they can be paired. That goes back to the thought that the immune oncology space in myeloma is going to be tremendously busy over the coming years and these types of assays will make that more valuable and more precise for the patients.

What is your biggest piece of advice for a newly-diagnosed patient with multiple myeloma?

An initiative we started last year, called the Right Track. The Right Track basically has three different pillars for newly-diagnosed patients. Get the right team, so go to a hospital or health care system that has extensive experience in treating myeloma patients. Get the right tests, so in conjunction with that team, get the right tests that look at your myeloma very specifically — either a genomic test or an immune test – so we know what your subtype is. Multiple myeloma has 12 different subtypes and it is very important to know your subtype and to know more about your disease. The third pillar is to treat it right. There are many treatments out there. There are 10 new drugs that have been approved over the last decade and a whole new wave of treatments that are coming out. So, you can get new treatments through consultation with your team, but also there are many clinical trials out there that your physician can refer you to. So, for all newly-diagnosed patients, we highly recommend you have the right team, the right test taken, which would allow you to have the right treatment.