Early Diagnosis and Treatment of Cancer Improves Survival Rates - Why Not Multiple Myeloma?
Dr. Irene Ghobrial of the Dana Farber Cancer Institute was on the Feb 12th Cure Panel radio program and her broadcast was exceptional, however I want to talk of one MAJOR takeaway I had from the program. If you missed it you can hear a rebroadcast if you CLICK HERE. Her point was simple, straight forward, logical, and impossible to argue against that Multiple Myeloma is the only cancer where we wait for it to metastasize and show organ, bone damage, or anemia before we begin treatment.
She provides examples of successes in breast cancer and colon cancer where we do massive screening and when we find the cancer, it is treated. DCIS or ductal carcinoma in situ is the most common form of breast cancer, and if found during a yearly mammogram the growth will be removed with a 100% 5 year survival rate; however if it is caught after metastasis or Stage 4 the 5 year survival is just 22%. For Smoldering Myeloma, which is an early diagnosis for myeloma, the Entire Myeloma Specialist community used the philosophy of "Watch and Wait." Dr. Ghobrial says many of her patients call this "Watch and Worry!" and as a result Dr. Ghobrial is on a mission to bring the same success to myeloma that we find in breast and colon cancer.She and many other specialists are coming to the conclusion that screening, early diagnosis, and early treatment is the future of myeloma treatment. There are a number of steps that must be taken to reach this goal. Those steps are as follows:
Step 1 - We need to determine which MGUS and smoldering patients will progress to active myeloma and are candidates for early treatment. Genetic testing may be the key to this step. For example just 10% of smoldering patients will progress to full blown myeloma, whereas 50% of high risk smoldering patients will progress. In MGUS only 1% of patients will progress, but some may have a genetic profile which indicates a higher likelihood of progression.
Step 2 - We need to prove early treatment will result in improved Overall Survival. A trial by Dr. San Miguel of the Spanish group conducted a trial for high risk smoldering myeloma and he stated the results were as follows:
Dr. San Miguel was the senior investigator on a phase III trial in which patients were randomized to receive lenalidomide and dexamethasone or observation, the latter being the usual standard of care for individuals who have an increase of plasma cells in the bone marrow that produce the monoclonal immunoglobulin (IgG), but do not have any myeloma symptoms.
San Miguel outlined the prognostic factors that allowed the research team to segment out the high-risk group, which included plasma cell bone marrow infiltration, IgG levels, and urinary protein levels.
“You want to give the patient what is needed, and nothing more than is needed,” San Miguel said.
This approach produced improved 3-year survival rates among the high-risk patients identified and treated by the Spanish team during the study; 94% of those who were treated were still alive at 5 years, compared with 80% in the untreated group.
You have a 6% chance of dying in 5 years if you are treated, and a 20% chance of dying in 5 years if you are not treated during the smoldering phase of the disease. You are therefore more than 3 times more likely to die if not treated. Average life expectancy for a patient with symptomatic high risk disease is just 2 years. More trials are in the works, however this is some very compelling evidence for early treatment.
Step 3 - We have simple blood tests for the measurement of M-protein and a more sophisticated test called the light chain test. Both of these tests together cost less than a mammogram or colonoscopy. However, these tests are not conducted during a normal physical and blood panel. Dana Farber will be establishing a clinical trial to conduct screening on a large scale to determine if screening, genetic testing, and early treatment can be a game changer like it has with breast and colon cancer. With talent like Dr. Ghobrial on Dana Farber's team, I feel it is not a question of if, but a question of when.In my opinion Dr. Ghobrial is a SUPERSCIENTIST, and a summary of her background is as noted below.
DR. GHOBRIAL SUPERSCIENTIST
Dr. Ghobrial is an Associate Professor of Medicine at Dana-Farber Cancer Institute at the Harvard Medical School in Boston, Massachusetts. She is a physician Scientist who specializes in the field of Multiple Myeloma and Waldenstrom Macroglobulinemia specifically in the precursor conditions of MGUS and Smoldering Myeloma. Dr. Ghobrial received her MD in 1995 from Cairo University School of Medicine, Egypt. She completed her Internal Medicine training at Wayne State University, Mich., and her Hematology/Oncology subspecialty training at Mayo Clinic College of Medicine, Minn. She is on many Dana-Farber and ASH committees. She reviews abstracts for the American Association of Cancer Research and top publications such as Blood, Lancet, and the Journal of Clinical Oncology just to name a few. She’s on the editorial board of the American Journal of Blood Research. Dr. Ghobrial reviews grants for the NIH, the Leukemia & Lymphoma Society and the MMRF and has won numerous awards including a Dana-Farber Clinical Investigator Award, the Robert Kyle Award for her work in Waldenstrom and more. She particularly focuses on the role of the malignant bone marrow niche in disease progression from early precursor conditions like MGUS/smoldering myeloma to active myeloma. Dr. Ghobrial and her lab examines how myeloma uses a process of cell dissemination to determine biological changes that occure during progression in myeloma. She seeks to understand that progression process from inactive to an active state. In addition, her laboratory research data has been rapidly translated to innovative investigator-initiated clinical trials. This lab has conducted over ten phase I and II clinical trials. Their studies on myeloma cell trafficking have been translated to the first chemosensitization trials in patients with Myeloma.
In addition, she is the co-leader of the first consortium of clinical trials for blood cancers in collaboration with the Leukemia & Lymphoma Society to form the Blood Cancer Research Partnership, a consortium of 11 community oncology sites coordinated by Dana-Farber. She has initiated a new clinic for the Prevention of Progression in Blood Cancers where patients with precursor conditions such as MGUS, early MDS and early CLL will be monitored before disease progression to see how the clonal evolution happens during disease progression. She just joined the MCRI as a member of the Scientific Advisory Board. Sounds like she is a SUPERSCIENTIST.