Are there any tests that can predict what myeloma treatments you will respond to?

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Are there any tests that can predict what myeloma treatments you will respond to?

this is a really great question.

We always kind of use urinary tract infections as the guideline, right?

So anyone who's ever had a urinary tract infection,

you pickup, they put it on a plate, they put little discs of antibiotics

on that plate.

And, you know, a day or two later off, I have this and this bacteria

and this antibiotic will work.

We don't yet have that in myeloma.

We kind of have that for a few drugs.

So venetoclax, which is an oral BCL two inhibitor,

seems to work in patients with an 1114 translocation.

But as far as the rest of the drugs,

we have some early preclinical data about what might predict,

but no test that you can go to your local physician and like give a drop of blood

or even a bone marrow and say, yep, 100%, this drug will work.

This is a super important question and a question near and dear to my heart,

because it's at the at the core of what the kind of research I'm trying to achieve

right now.

We really struggle to determine which patient

is going to get the best response from each drug

because their disease is so different.

No two patients have the same myeloma.

They differ based off of their genetics.

So at the molecular level, these are not the same tumors.

I can give you an example of a research study

that we recently published where we did high throughput drug sensitivity testing.

We took myeloma cells into the lab and we tested them across

a lot of different compounds and we watched the cells grow

in those compounds in the lab and we would then be able to calculate

which drug is causing the cells to die the fastest,

and we would then rank those drugs

and provide that list back to the doctor.

And on that list, the doctor could choose, well,

this drug you've not had before this drug, you know your insurance will pay

for taking into account those types of things.

They would select the drug that would be most feasible

and give that to the patient

and the patient within monitored to see if they had a response.

In this study, more than 90% of patients

whom we were able to use this assay guided therapy

were able to achieve a response to it.

So we think these kinds of tests are the future for myeloma,

and we're very excited about potentially getting them into the clinic in the

in the near future.

So there are studies that

they demonstrate, for instance, that in African-American patients

who often have translocations 1114, they have a good response to REVLIMID.

There are studies also looking at translocation 1114 which show

that patients who have transaction 1114 have an excellent or have a good response

to venetoclax, and venetoclax is a drug that you can use in that setting.

So there are other tests that one can potentially do,

such as next gen sequencing, a mutation analysis

that might give someone a clue as to what mutation that might have

and whether on a clinical trial or down the road there may be drugs that

are already available for other cancer that may be applicable in that setting.

It's a combination of tests that we look at.

There are data looking at proteasome inhibitors in high risk settings.

It suggests that, you know, it is useful to have those indoor settings.

So I don't think there is any one slam dunk test,

but I think it's an aggregate of the data that help us decide.

I think this is what might be appropriate for for a particular patient.