Dr. Noopur Raje, MD
Massachusetts Cancer Center and Raje Lab

Interview date: January 17, 2014

Myeloma cells can't survive outside of the bone marrow. Dr. Noopur Raje, MD, of Massachusetts General Cancer Center tells us that the "soil" in which they are growing is an important target for new treatments. Dr. Raje describes her work to make the bone marrow neighborhood as unfriendly as possible to stop the growth of myeloma cells. She describes how current myeloma drugs can change the bone marrow environment: Proteasome inhibitors  boost new bone growth while the IMiDs  boost immunity and bump up natural killer cells. She then expands the capacity of those drugs using a new HDAC inhibitor called ACY-1215 with existing myeloma drugs. In one study, Velcade blocks the protein pathway while the HDAC inhibitor blocks another pathway and prevents the cells from becoming Velcade-resistant. She uses another example of combining this same new drug with  IMiDs to affect a commonly mutated gene called C-Myc. She describes a trial for older patients using a standard triple combination that can be modified for age by lowering the dosage (RVD Lite). She regularly performs genetic testing as part of her standard care and is looking to target specific genes, using the BRAF and MEK genes as examples. Her research suggests that treating the bone marrow environment can also help to heal bone lesions. Dr. Raje reminds us that the 9 new myeloma drugs in the last 10 years came about because patients participated in myeloma trials. She notes that when patients wait to join a clinical trial when they are out of options, it is not really helpful, and encourages patients to take advantage of early access to therapies that go beyond the standard of care. 

The live mPatient Myeloma Radio podcast with Dr. Noopur Raje