Do refractory and relapsed patients have a chance of effective treatment :: MedExpress.pl

Multiple myeloma: do refractory and relapsed patients have a chance of successful treatment?

– “Rally for health” is a phenomenal event. I participate for two reasons. Firstly, I hate myeloma and secondly, I really like cycling. This event combines hatred for myeloma and love for cycling – says Polish Myeloma Consortium president Dr. n. med. Dominik Dytfeld, of the Department and Clinic of Hematology and Bone Marrow Transplantation, Pozna Medical University.

– “Rally for health” is a phenomenal event. I participate for two reasons. Firstly, I hate myeloma and secondly, I really like cycling. This event combines hatred for myeloma and love for cycling – says Polish Myeloma Consortium president Dr. n. med. Dominik Dytfeld, of the Department and Clinic of Hematology and Bone Marrow Transplantation, Pozna Medical University.

We talk and care about myeloma patients. While it is still an incurable disease, the advancements in treatment are fascinating. Fortunately, Polish patients are also the beneficiaries.

I am a witness to this progress and, if possible, a participant. In the 20 years that I have been caring for myeloma patients, the progress has been evolutionary. Because evolution, unlike revolution, is something long lasting and in the right direction. Patients live longer and better. If someone looks at the patients, they won’t say they’re people with myeloma. This is due to the fact that we have new drugs that are being combined into increasingly effective combinations. We can treat myeloma better, more effectively and also safer. And this means that the vast majority of patients return to normal life and fulfill their social, family and professional roles. And it’s fascinating. In fact, we can’t cure myeloma yet. But because progress is constantly being made, I hope that in 5 years time, during an event similar to this one, we will no longer say that the myeloma has broken, but that the myeloma has spread.

Myeloma patients now live many years. It is therefore important to be able to apply the right therapy at the individual stages of treatment. We know that in the coming years, patients with myeloma may develop resistance to the current treatment. How do we deal with the treatment of patients in the third and fourth line?

This is the essence of this disease. And how we treat this disease from the beginning in almost every patient, so that resistance develops. And that’s the problem. The strategy for treating this cancer is different from the others because we know that this resistance will develop. We need to plan this treatment. We know more or less what we will give in the second, third and fourth lines. And the truth is that despite so many new drugs that are used in the first stage of the disease, then they run out. This is the worldwide truth. The fact that the development continues is precisely for those patients who are treated with the third, fourth, fifth, sixth line (and I have such patients myself). And we never leave our patients alone. We always “patch” drugs and try to find something for the patient.

What is the role of anti-CD38 antibodies in refractory and relapsed patients?

It is the primary drug in the treatment of myeloma. We have two drugs, daratumumab and isatuximab. They are super safe drugs, indifferent from the perspective of toxicity. However, they significantly increase the effectiveness of the therapy. And these drugs should be used in the first line (they are a little lacking, although they are registered). We’re missing daratumumab in the first line, but then we’re also missing isatuximab, a similar molecule. These drugs are also missing in the later stages of treatment.

Generic drugs also appeared. Shouldn’t the savings here be spent on treating patients in the third and fourth line?

Yes. We hope so – we greet the minister – because one of the basic drugs in the treatment of myeloma, namely lenalidomide, is already a generic drug. The amounts allocated to fund this therapy have decreased significantly and we sincerely hope that the remaining funds will remain under this disease as there are ongoing needs. We have a good first line, a relatively good second, but III and IV are weaker and we should continue to develop these therapies and increase access to modern medicines for the Polish patient. Unfortunately, these are costs. It is a challenge. Thanks for making it better and better, but we’d like more.

We are in Pozna, Malta, so we are thinking about the Hematology and Transplantation Department and Clinic, CAR-T.

I’m glad you’re talking about it. I work in the team of Prof. Goudvink. We had the first CAR-T in Poland in lymphoma, the first CAR-T in an adult patient with ALL, the first CAR-T in a patient with myeloma in Poland. I am very happy to be able to participate in this development. This is a therapy that will change everything. I liken it to “Star Wars”, where the spaceships moved fast, went super fast. We are at this stage. CAR-T is already registered on the later third and fourth lines. But there are also studies with their participation in primary care. And maybe not today or tomorrow, but in a few years CAR-T will be used at the very beginning of treatment, in transplant and non-transplant patients. And then we no longer say that myeloma is an incurable disease.

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