Recent breakthroughs expand treatment options for multiple myeloma
A treatment approach harnessing bispecific antibodies to target cancerous cells unlocks new possibilities for patients, says an expert.
by Brand Studio · CNA · JoinIn 2022, Ms Patricia Wong’s life was disrupted when severe back pain made it impossible for her to sit or lie down comfortably. She endured sleepless nights on her sofa before consulting a general practitioner, who referred her to a hospital. Further investigations revealed that she had multiple myeloma, a form of blood cancer, as well as a tumour in her colon.
Her back pain was a symptom of the cancer, which had weakened her bones, leading to fractures in her vertebrae.
Ms Wong, now 47, is far from alone. In Asia, there has been a notable uptick in the incidence of multiple myeloma. Age plays a significant role, with 70 being the median age of diagnosis, though the reason for this correlation remains unknown. Additionally, a small minority have a family history of the disease. Today, multiple myeloma ranks among the most prevalent blood cancers globally, claiming approximately 106,000 lives annually.
MANAGING MULTIPLE MYELOMA
In a healthy body, plasma cells found in the bone marrow produce antibodies that are crucial for combating infections. But when multiple myeloma strikes, malignant plasma cells multiply rapidly, displacing healthy cells and disrupting their normal function.
According to Dr Chen Yunxin, senior consultant haematologist at Singapore General Hospital and National Cancer Centre Singapore, multiple myeloma can impact various parts of the body. Its symptoms are wide-ranging, which makes the disease harder to recognise and treat. Some patients show no symptoms, while others may experience bone pain or weak bones, anaemia leading to fatigue and difficulty breathing, unexplained fevers, recurrent infections and kidney damage.
Despite the availability of effective treatment options, myeloma cells can become resistant to treatment and acquire new genetic mutations over time, resulting in a continuous cycle of remission and relapse. However, with newer treatments available, patients with multiple myeloma may see improvements in the prognosis of their condition.
Dr Chen noted that a wait-and-see approach may be adopted for early-stage multiple myeloma, also known as smouldering multiple myeloma, with close monitoring through regular check-ups. For most other patients, the three main treatments typically prescribed are targeted therapy, immunotherapy and chemotherapy. “As symptoms vary from patient to patient, recommending a treatment plan involves striking a delicate balance: Effectively controlling the disease while minimising side effects,” she said.
As a result, each patient follows a unique treatment pathway, potentially undergoing multiple treatment regimens throughout their illness.
According to Dr Chen, challenges emerge when patients experience recurrent relapses that tend to escalate with each instance, shortening the remission periods. Relapse occurs when cancerous cells that have survived treatment continue to multiply in the body, becoming more aggressive with each new line of therapy attempted.
Ms Wong’s initial treatment plan included multiple rounds of chemotherapy and a stem cell transplant, neither of which provided sustained remission in her case. She remained in pain and found it difficult to walk.
“Despite significant scientific advancements, patients who develop relapsed and refractory (resistant to treatment) multiple myeloma after exposure to the three main forms of treatment have limited options and generally face poor outcomes,” said Dr Chen.
She estimated that patients typically undergo four or more lines of therapy, with diminishing responses to each subsequent treatment. Up to 50 per cent of patients with advanced or high-risk multiple myeloma experience relapse in less than three years and less than 30 per cent survive more than five years.
In Ms Wong’s case, she began to see improvement in her health only after starting her third line of treatment, which utilised varying treatment options available for multiple myeloma.
NEW INNOVATIONS OFFER HOPE
02:23 Min
New therapies offer renewed possibilities for those with multiple myeloma. Video: Johnson & Johnson
In recent years, innovative breakthroughs have offered new hope for patients like Ms Wong. According to Dr Chen, one noteworthy approach harnesses bispecific antibodies that are engineered to bind to two different targets simultaneously. This treatment is an option for patients who have received at least three prior therapies and have shown disease progression.
These antibodies target both multiple myeloma cells and T-cells (cells engaged in fighting harmful pathogens), activating the patient’s immune system to identify and eliminate multiple myeloma cells throughout the body.
“Clinical trials have shown that 63 per cent of patients responded to this treatment, with nearly one in two patients achieving a complete response, which means that there are no more signs of cancer,” said Dr Chen.
Another promising immunotherapy is CAR-T cell therapy, which involves modifying a patient’s T-cells to recognise and attack cancer cells. Currently, CAR-T cell treatment for myeloma is not available in Singapore outside of clinical trials.
While innovative therapies hold promise as a viable treatment for multiple myeloma, the individualised nature of treatment pathways underscores the importance of patients consulting their doctors to determine the most suitable option for their needs.
When facing difficult treatment decisions, Dr Chen recommends involving trusted family and friends for support and to help weigh the options.
Buoyed by the encouragement of her loved ones and the understanding of her employer who wholeheartedly accommodated her treatment schedule, Ms Wong was able to face her diagnosis with courage and optimism.
She also became involved with support groups and advocacy efforts to learn more about multiple myeloma and help others facing similar battles. Ms Wong takes joy in her work and makes the most of each day with family and friends.
Learn more about multiple myeloma.
This advertorial is meant for disease awareness and educational purposes only, and does not endorse, make reference to and/or recommend any product. Reach out to your prescribing physician to learn more about the treatment options for multiple myeloma.
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