Multiple myeloma is probably not on your radar. 

There’s no routine screening test for this cancer, and the average person’s risk of developing myeloma in their lifetime is less than 1%.

“It’s important to have knowledge and awareness of increased risk of myeloma in certain ethnic groups, particularly people who are Black, as well as those older than 65. If a first degree relative has myeloma, there’s also a higher risk,” said Matthew Pianko, M.D., a hematologist who specializes in multiple myeloma at the University of Michigan Health Rogel Cancer Center.

Multiple myeloma is a cancer that develops in the plasma cells, an integral part of the immune system.

“There have been dramatic improvements in myeloma treatment over the last 20 years, with survival jumping from two to three years to well over 10 years now. The challenge with myeloma, though, is that it’s still not a curable disease,” said Pianko, clinical associate professor of hematology/oncology at Michigan Medicine.

Here, Pianko outlines some recent advances that have him excited for the future of multiple myeloma treatment.

1. New drugs that target the immune system

Multiple myeloma affects cells that are integral to the immune system. Now, a new class of immune-based drugs are harnessing that connection to treat the cancer.

Three of these drugs, collectively called bispecific antibodies, received approval from the U.S. Food and Drugs Administration over the last three years: teclistamab (brand name Tecvayli), elranatamab (brand name Elrexfio) and talquetamab (brand name Talvey).

Think of bispecific antibodies like two-sided Velcro straps. One side sticks to the immune cells; the other side sticks to the cancer. 

The drugs are designed to bring those two sides close together to stimulate the immune cells to attack the myeloma cells.

In patients who had received four previous treatments, 60% responded to the drugs and in about a quarter the tumors were completely eliminated.

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Now, Pianko is working to create a new clinical trial to look at introducing bispecific antibodies in combination with other myeloma drugs as a first-line treatment.

“Hopefully as we bring some of these more effective options earlier on we can move toward a cure,” Pianko said.

2. Reprogramming patients’ own immune systems

CAR T-cell therapy was first FDA approved in 2017 for certain types of leukemia and lymphoma. It also turns the immune system against cancer, but in this case by reprogramming a patient’s own cells.

Recently, CAR T gained approval for patients with multiple myeloma who have had one previous round of treatment.

CAR T-cell therapy involves taking immune cells out of a patient’s body, modifying these cells to target and kill cancer cells, then reinfusing the modified cells into the patient. 

The modified immune cells find their target on the cancer cell surface and kill those cells.

Studies have shown up to half of patients with multiple myeloma have lasting remission after CAR T-cell therapy. While it can be helpful, Pianko notes that CAR T does not cure myeloma.

3. Learning more from genetics

“Multiple myeloma has one name but is likely a number of different diseases under the same umbrella. We’re finding different types of myeloma that behave differently,” Pianko said.

Recent studies analyzing the genes in tumor samples from patients with multiple myeloma have identified certain genetic markers or abnormalities tied to more aggressive disease and other markers tied to lower-risk disease. 

The next step is to use this information to select specific treatment approaches for individual patients based on these genetic markers.

Pianko and colleagues at Rogel are working to create a myeloma-specific panel of genes for Rogel’s precision oncology sequencing program to make this approach standard for patients.

4. Access to clinical trials

Current treatments have significantly improved survival rates for multiple myeloma, but while a drug may work for a while, the cancer eventually becomes resistant and returns.

“Access to clinical trials is so important for patients with multiple myeloma,” Pianko said.

The Rogel Cancer Center team has about a dozen clinical trials for multiple myeloma that span the gamut of diagnoses, offering options for patients newly diagnosed up to those who have had the disease for a decade or more.

For questions about multiple myeloma, contact Rogel’s Cancer AnswerLine at 800-865-1125.

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