Dr. David Siegel, MD, PhD John Theurer Cancer Center Interview Date: April 15, 2016 

If multiple myeloma patients relapse or become refractory to existing medications, it doesn't mean the disease has won. Dr. David Siegel explains the difference between "relapsed" and "refractory" and shares a hopeful message that the new drug combinations give doctors and patients so many more tools to use. He tells us that just because one drug or even class of drugs (like proteasome inhibitors or iMiDs) have stopped working doesn't mean they won't work again when used in a different combination. Dr. Siegel says that no longer can patients be given a specific timeframe for survival because investigators are just at the beginning of understanding which combinations may be right for which patients. He shares pomalidomide as an example of a new, potent drug that is great for patients with kidney issues because it is not excreted through the kidneys. Pomalidomide also extends the effectiveness of other drugs. He uses the HDAC inhibitors as examples of drugs that do nothing by themselves, but can re-energize drugs that have stopped working. For example, patients who became refractory to Revlimid  used Vorinostat and the Revlimid started working again, even when the myeloma hadn't changed genetic features. Dr. Siegel mentions metabolomics, or taking advantage of a cancer cell's weaknesses with the body's metabolism. He concludes with recommendations to not exclude any therapy as an option and that different combinations can be used according to the NCCN guidelines off-label based on individualized patient needs.

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