Dr. Ravi Vij, MD Washington University School of Medicine Interview Date: January 29, 2015 

Dr. Ravi Vij, MD, discusses newer options for relapsed/refractory myeloma patients. He shares that little is known about why some patients become drug resistant and says that drug resistance can't be predicted. He notes the complexities of myeloma, that there isn't a single clone of the disease in each patient, but rather sub-clones where one could be affected by treatment and other resistant to treatment. He shares the use of the new monoclonal antibodies elotuzumab and the two new anti-CD38 monoclonal antibodies. He also shares that the newer drugs carfilzomib and pomalidomide are helping relapsed patients and may give better response rates. He mentions several other new inhibitors that may also be effective for relapsed patients including ARRY-520, KPT-330 and Ibrutinib. These are still in the early stages of study, but represent a growing number of newer options being tested. He notes that the field is maturing, with new genetic testing able to identify specific genes that are mutated in myeloma and other cancers. He describes the difference between the gene expression profile (GEP) and whole genome sequencing and tells us that the $1000 genome test is here today, but says the challenge is finding the people and systems to interpret that data. He describes "personalized medicine" and "precision medicine" and suggests that these new ways of looking at myeloma and cancer in general may require a different approach to clinical trials. The Myeloma Crowd Radio Show with Dr. Vij