Forward, by Hakan Gem
I recently read an op-ed that examined a longstanding issue in how the mainstream discusses cancer, and it’s an issue that has been on my mind for years.
A cancer diagnosis and the ensuing treatment are often framed as a battle that a patient, their family, and their doctors must all collectively fight. And what are the stakes? Only your life, which will be lost if this battle is too overwhelming for your team. What can you expect? To fight like hell with absolutely no guarantee that your efforts will win you the battle. Can you see the problem with this line of thinking? This War on Cancer is a poorly conceived and long antiquated path to solve one of the most daunting challenges humanity has ever faced.
If you think that’s hyperbole, let me take a moment to paint a picture for you.
Cancer will claim more lives in the US this year than accidental deaths, chronic respiratory diseases (like asthma or COPD), and strokes, combined. Those are the third, fourth, and fifth projected leading causes of death. Cancer, which currently sits at the #2 spot, is projected by the CDC to overtake heart disease as the #1 US killer before 2020. And to give you an idea of what that actually means: over 600,000 people will die of cancer this year, next year, and every single year after that until we figure it out.
If you populated a city with the number of people who die of cancer every year, it would be the 30th most populated city in its first year. It would break the top 10 in only its second year, become the second largest city ahead of LA in six years, and it would surpass New York as the largest US city in just over a decade.
This is not a war. This is the most overlooked problem that we are not talking about on a daily basis.
I don’t paint this picture because I’m a pessimist and I enjoy dwelling on the atrocities of life. I paint it because I feel as though we’re all asleep at the wheel when it comes to our current state of healthcare, and I feel an obligation to help us wake up and see the road more clearly.
When we repeat the tired metaphor of waging a battle against cancer, we perpetuate the myth that this is a fight that can be won simply by trying harder. Countless lives have put forth their greatest effort to “be strong” and “never give up” only to succumb to this disease we don’t yet fully understand. So that’s where our efforts need application – in understanding cancer, not fighting it.
And that’s where the goal of LiveSmyle’s Research Corner comes into play. This monthly segment, spearheaded by future doctor Becky Gold, is one arena where this understanding can take place. Becky looks at the latest research that is published across various scientific journals and provides a concise and informative summary that can be digested by just about anyone, no matter your scientific or medical background.
It may not be the most glorious path filled with inspiring imagery, but I am convinced that a new framework of cancer awareness supported by education rather than a battle-cry will be the most effective tool moving forward.
So, without further ado, let’s get to the good stuff and learn about the latest in cancer research.
Multiple Myeloma: A New Hope
March is multiple myeloma awareness month! In honor of this, the study we will look at will be about a new drug combination for relapsed/refractory multiple myeloma. Multiple myeloma holds a special place in the hearts of the LiveSmyle family, so I am excited to shine a spotlight on it this month.
Multiple myeloma is a type of blood cancer. It is characterized by the proliferation of plasma cells, resulting in lytic bone lesions, osteopenia, and/or fractures.
Worldwide, there are about 160,000 new cases and over 100,000 deaths each year due to multiple myeloma. There is great variability in prognosis —some patients can go years without needing treatment, while others do not respond to immediate intervention. Despite significant progress that has been made in multiple myeloma in recent years, many patients have relapsed disease — it is initially eliminated but then later returns — or refractory disease — it does not even respond to immediate treatment. Want to learn more? Check out UptoDate.com or watch this video from Khan Academy.
Proteasome inhibitors (PIs) are drugs that block the actions of proteasomes — cell complexes that break down proteins. These drugs have been studied and used in multiple myeloma, and there are three currently approved for use by the FDA. The idea behind proteasome inhibitors is that these drugs may block the proteasomes that break down pro-apoptotic factors (factors that lead to programmed cell death). If these pro-apoptotic factors are not degraded, the cancer cell would then proceed with normal, programmed cell death as desired. Watch them do their work here.
Histone deacetylase inhibitors (HDACis) affect the way that cellular DNA is accessed for replication, which then allows the cell to be targeted for further therapy. Check out this video (it even mentions the use of HDACis with PIs, which is what this study looks at).
This study focused on a drug combination including a PI and an HDACi which had previously been shown to have activity against relapsed/refractory multiple myeloma. The goal of this study was to examine the safety and efficacy of the drug combination in the setting of a clinical trial. Participants in this drug trial had previously received, on average, 4 prior lines of therapy. The results demonstrated that safety of the drug combination was consistent with or better than the previously reported safety of the medications individually. The authors concluded that this new drug regimen was safe for patients with relapsed/refractory multiple myeloma.
This new drug combination could be a potential solution for multiple myeloma patients who have not had response to our current therapies (or have relapsed). This offers patients — and their families — another shot at longer survival. For a disease such as multiple myeloma, this is significant.
It is important to remember, however, that this is a Phase 1 trial — it’s main purpose was to determine whether or not this combination was safe for patients. As a result, we have very little evidence (currently) about how long, if at all, life expectancy could increase with this therapy. Furthermore, while this study shows the drug combination is “safe” for patients, many patients had some fairly unpleasant side effects, and a few had “adverse events” (leading to their discontinuation of participation in the trial). However, these side effects were not dissimilar to other multiple myeloma therapies.
With this new data showing the safety of the drug combination, future studies should look at the best dosage regimen to increase tolerability and efficacy, as well as gain a stronger understanding of the degree of patient benefit. Ultimately, this study should give us some hope about the future of multiple myeloma therapies.
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