When should a patient consider a clinical trial in relapse?

Who should consider participating in clinical trials at relapse and why should they consider participating?

That's a great question. So who should really consider participating in clinical research or clinical trials at time of relapse? I would say typically everyone, because hopefully so I can say that when I when my patients that are myeloma relapses and we're discussing treatment options, I always think about the different options and then try to boil it down to the two, maybe three or even one if there's clearly a correct answer of the best possible options. Often a clinical trial is part of that. So there may be situations where there is a standard of care, FDA approved option for treating the myeloma, and then we have a study option.

And I would hope that everyone would consider studies. It doesn't always mean that a study is the correct answer, but we should always consider them because studies often present an opportunity to get newer therapies which may not be FDA approved or they are FDA approved, and we're using them in a slightly different way.

And in doing that, we of course, hope that it's going to be better, so more effective in controlling myeloma and or reduce the risk of side effects.

And so, you know, it's an option to get a therapy that's possibly better that would not be available outside of a clinical study.

And then the other tremendous benefit to participating in study is, is that it allows us and it helps us as a myeloma investigators and the field in general to get smarter about myeloma.

And what that means is that the smarter that we get, you know, the better we get at treating myeloma, which means that people down the road do better with this and that when I think about the benefit of clinical trials and cancer in general and myeloma is no exception to this. You know, the only reason that we have this huge menu of different treatment options today in multiple myeloma in 2023 is that people who have had this before have participated in studies.

That's how new medications are explored. That's how new medications get FDA approved. And so the only way we get better at this is if we participate in studies. And so I guess I'd say to sum up that when clinical studies are appropriate for a person, it's a way of us myeloma or we and myeloma investigators to to treat a person's myeloma, to help the individual person that we're sitting in front of that has it, and then also get smarter and advance the field so that we can help people in the future and get better at this in general.

And, you know, hopefully someday find the cure for this

So, you know, I mean, I would start to consider clinical trials first for any patient that I see. So I think it's a discussion we have with every patient, you know, who has relapsed disease. And then, you know, it's an informed discussion.

And we also have to take into account, you know, patient considerations, logistics, and whether they'll have that, you know, support mechanism to participate in a clinical trial.

I think, you know, for patients who participate in clinical trials, they always have extra pairs of eyes looking over the data, so they have more people watching over them. That's a big advantage. And and especially for patients, you know, who have more advanced myeloma, where commercial treatment options are limited, you know, the only way patients can get new treatments is through clinical trials.

But in general, does it, regardless of whether, you know, it's a smoldering myeloma patient, newly diagnosed or a relapse patient, it's important to think about clinical trials and participate in them.

The short answer is that everybody should consider a clinical trial at relapse. Relapsing Multiple myeloma is really what kills patients.

Myeloma is are sensitive to chemotherapy at the beginning, but then relapse continually or sequentially until you get to the point where there is nothing that is effective against the myeloma.

So understanding why those why people relapse, why how did their myelomas become resistant to therapy and how you can target that is probably going to be an essential point or an essential understanding to really cure myeloma, because it's not the fact that you don't respond to chemotherapy at the beginning.

It's that you relapse with persistently more difficult to treat clones. So clinical trials really help us understand and define new therapies to prevent relapse. And for example, we have a clinical trial that we just completed that targeted a particular molecule called CD28 that is actually important for myeloma cells to become resistant to chemotherapy. So you can actually turn off CD28 or block it.

And then all of sudden myeloma is that used to be resistant to chemotherapy, are now sensitive to it again. So we can actually turn back the clock on myeloma to something that look like what the myeloma looked like in the beginning. Those are clinical trials. That's where that understanding is going to be. That's where all the breakthroughs are going to come from