Immunotherapy May Be the Future of Myeloma Treatment

Recent findings suggest focusing on the immune aspects of myeloma may bring new solutions to patients.

While most myeloma patients experience remissions lasting less than three years, a select few have no signs or symptoms for 10 years or more. Research suggests that lasting success may be due to immune system differences that promote disease suppression.

“The hematology community is coming to the realization that a key element in the way forward is to better understand and treat the immune aspects of myeloma,” Dr. Brian Durie, a multiple myeloma specialist at the Cedars-Sinai Medical Center, said. “We need a better understanding of what causes relapse, and we need to develop new therapies that overcome that resistance. We need to remember these obstacles when we are developing new treatments.”

Among the promising results presented at ASH last year were several on immunomodulating therapies, including two phase I studies of anti-CD38 antibodies. Antibody-based therapies target molecules on cancer cells, making them more visible to both the patient’s immune system and other cancer treatments.

Another area of interest in immunotherapy for multiple myeloma is genetically modifying a patient’s own immune cells to target and destroy the cancer cells. One such therapy is known as chimeric antigen receptor (CAR) T-cell therapy. The promising results of several CAR T-cell therapy clinical trials in myeloma, as well as acute lymphoblastic leukemia (ALL), chronic lymphocytic leukemia and acute myelogenous leukemia, were also presented at ASH in 2014.

Recognizing the potential of immunotherapy in multiple myeloma, Celgene has established several strategic collaborations to leverage these advances in immunotherapy over the past few years. In 2013, Celgene began collaborating with bluebird bio and the Baylor College of Medicine to discover, develop and commercialize antibodies for B cell-mediated blood cancers.

This spring, Celgene announced a collaboration with AstraZeneca/MedImmune Limited to research a pathway that tumor cells hijack to evade the immune system. By targeting this pathway for inhibition, the aim is to improve the ability of the patients’ immune cells to attack blood cancer cells, including myeloma cells.

More recently, Celgene and Juno Therapeutics, Inc. agreed on a long-term collaborative partnership to bring CAR T-cell therapies and T cell receptor technologies to market for cancer patients.

While the results from preliminary studies of these immunotherapy approaches are promising, whether they will improve patient outcomes in the long run remains to be seen. “We’re now exploring whether it’s possible to get rid of every myeloma cell and effectively cure patients with these new therapies,” Durie said. “We’re focusing on looking for residual disease to determine whether we need to continuously modulate the immune system in these patients.”