Dr. Gareth Morgan, PhD, FRCP, FRCPath Interview date: November 8, 2013 

 Dr. Gareth Morgan shares his approach to personalized medicine in multiple myeloma. He reiterates that myeloma is not a single disease, but a group of diseases with different prognosis and natural history. He explains how he first identifies high-risk myeloma and then looks at patients at a molecular level with FISH, gene expression profiling, and a new test called RQ-PCR (a quick and inexpensive test) to identify misbehaving genes. He notes that RAS mutations are present in 50% of myeloma patients (he believes it to be driver mutation) and that MYC mutations are present in about 20% of myeloma patients. He believes that the top candidate myeloma genetic targets are drugs that inhibit MEk and the RAS pathway. He gives us a preview that drugs are in development that may be able to switch off MMSET, the gene that is deregulated in the 4;14 translocation. He shares his view of the future - the ability to identify actionable mutations where treatments may already exist in other forms of cancer that can be used in myeloma. He describes the challenge to subdivide patients for more personalized treatments in myeloma without a global, standardized approach for testing. He shares his research hypothesis for the transitions of MGUS and smoldering myeloma into active myeloma, thinking that he would find one or two mutations that drove the activation, but found instead that the trigger may be the effect of myeloma cell secretion that changes the bone marrow environment which then kicks myeloma cells into high gear. As a result, he recommends that we look at how myeloma changes the bone marrow micro-environment. He also recommends that if we want to achieve a cure, that we front load treatment to knock out  the majority of the cells to prevent regrowth. He shares his belief that "knowledge is power" and advocates participating in clinical trials to help move research forward.    The live mPatient Radio podcast with Dr. Gareth Morgan