new therapies transform blood cancer treatment and extend lives
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emerging science in multiple myeloma cancer treatment highlights the possibilities of immunotherapy.
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one of the greatest challenges with multiple myeloma is the progressive form of this blood cancer. patients become resistant to conventional treatments and live with the near certainty that they’re running out of time.
“i’m continually amazed by how people cope,” says dr. donna reece, a leading multiple myeloma physician. “it is like having a huge monkey on your back. you cope and try to make the best of it, but there is that knowledge and that fear that this disease is most likely going to come back. that is a terrible burden, and i think many people will say that they get very stressed before their evaluations, thinking ‘is this when i’m going to get bad news?’”
multiple myeloma: a common cancer difficult to treat
while she’s on the frontlines of seeing people with this incurable cancer in the clinic, she’s also the director and professor of medicine in the program for multiple myeloma and related diseases at the university health network (uhn) in toronto.
multiple myeloma is the second most common blood cancer in canada, following leukemia. to put this in perspective, in 2024, more than 4,000 canadians were diagnosed with multiple myeloma at the rate of 11 new diagnoses every day, and 1,720 lost their lives to it.
although multiple myeloma doesn’t have the name recognition of leukemia and is often confused by the public with melanoma skin cancer, it is a common cancer that is challenging to treat.
“this cancer is like a weed in the bone marrow, and it gets more stubborn the more different weed killers you put on it. it’s more resistant. so, you need more and more sophisticated treatments,” dr. reece explains.
patients struggle with bone pain, fatigue and anemia
multiple myeloma happens when healthy plasma cells in the bone marrow become cancerous and multiply uncontrollably. typically, these plasma cells produce antibodies to fight infection. but the multiple myeloma cells spur an overproduction of abnormal proteins that cause serious health issues, including damage to the immune system and bones (and often severe bone pain) and kidney problems. bone damage, fatigue and anemia are the hallmarks of the disease.
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reece started out as a stem cell transplant physician looking after leukemia and lymphoma, and moved into the specialty of multiple myeloma when the disease became a target for stem cell transplant in the late 1980s. stem cell transplants replace damaged bone marrow, and the procedure is still offered to people who are considered well enough—typically younger and healthier—to undergo the transplant.
by the early 2000s, new drug therapies were developed to provide control between relapses, extending people’s lifespan and giving them hope.
the more treatment tools in the toolbox, the better
dr. reece notes that advancements in pharmacology have been transformative regarding multiple myeloma treatment.
“we’re milking every bit of benefit out of each drug, as long as it lasts, because the disease recurs. then, if we have another treatment to suppress it, we can get things back on track. but the disease is going to come back, so we depend on having these different sequential treatments,” she notes, adding, “eventually, though, we run out of treatments and then the disease is fatal.”
the most recent step forward for multiple myeloma in the last few years is immunotherapy, giving immune substances, either cells or antibodies, to help the body’s own immune system recognize and attack cancer cells. unlike chemotherapies and other agents designed to directly eliminate cancer cells (also destroying healthy cells in the process), immunotherapy doesn’t come with the toxicity of traditional cancer therapies.
as experts agree, immunotherapy represents a shift in how we think about treating cancer and other diseases with emerging science.
“it’s a very heterogeneous disease and not everyone has a good outcome, so we need lots of tools in the toolbox,” dr. reece says. “there are a number of immune treatments, and if we can use those in sequence, we are now seeing people live even 20 years,” instead of an average of five to seven years that’s typically seen with this type of cancer.
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“i have patients that i saw in 2001. after going through a number of effective treatments, they are still doing well, and that was just unfathomable early on.”
trojan horse action kills cancer cells in the blood
the latest in multiple myeloma medication attacks the blood cancer cells in a different way. blenrep (belantamab mafodotin for injection) has a unique “trojan horse” mode of action where what’s called a monoclonal antibody (produced in a lab to mimic antibodies in the immune system) is injected into the body. it binds to a particular protein expressed on myeloma cells, so it’s right inside the cancer cells, and here’s the trojan horse—the antibody carries a cytotoxic agent that can now work to kill the cancer cell.
“we’re going in and not triggering the immune system until we need to, which is really unique, and that’s been evidenced as we see the various clinical trial programs come to light,” says dr. michelle horn, country medical director at gsk in canada, the biopharmaceutical company behind blenrep.
gsk reports that clinical trial data on combination therapy with blenrep for overall survival shows a 43 per cent reduction in the risk of death for relapsed multiple myeloma patients, which is significant, dr. horn notes.
she’s excited by the research that’s opening doors to new therapies that are safer and more effective.
“we have this understanding of the role that the immune system plays and there’s that convergence of a lot of the different pieces of science that we’ve seen, whether it be the knowledge that we have from infectious diseases or the knowledge that we have from the immunostimulant inflammatory space which we’ve been working in for a long time,” she says.
patient-centred focus in drug development
“we’re bringing those together with the oncology and leading into a space of targeted therapy, which is no longer this series of cycles of chemotherapy, to fundamentally change the landscape in oncology.”
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another part of the shift in treatment is the patient-centred focus on quality of life factors, such as simplifying how the medication is administered for outpatients, rather than spending long hours in a cancer clinic, and limiting side effects. drug treatment with blenrep combinations, for example, can be offered as outpatients, improving access for people in far-ranging geographical locations or those with mobility challenges.
as dr. reece says, cancer medicine used to focus on one goal: to get the disease under control at a high price in terms of side effects. chemotherapy commonly brings on nausea and vomiting, increased bruising and bleeding, fatigue and risk of infection, and the list goes on. now, studies evaluating drugs include quality of life assessments and patient voices and concerns, so treatment is moving in a positive direction.
what should people living with multiple myeloma and their families know about the growing options for sequential treatment?
“having hope is very helpful, and you know in myeloma, that hope has been realized with these amazing new drugs,” reece says. “i’ve seen people raise their kids and see their grandkids. that was unfathomable 25 years ago, except for the very rare individual.”
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