The Role of Lifestyle on MGUS Progression | Betsy O’Donnell, MD | ASCO 2023

Hi, I'm Betsy O'Donnell from the Dana-Farber Cancer Institute, and I'm going to talk to you today about precursor disease, specifically MGUS, which is monoclonal gammopathy of undetermined significance and smoldering multiple myeloma. These are both conditions that can in some patients evolve into the cancer of multiple myeloma. I work at Dana-Farber, and the goal of our program, which is called the Center for Prevention of Progression, is to identify ways in which we can thwart the progression of these early precursor disease into active multiple myeloma. So we're very fortunate to have a center that's dedicated to this. I think we're really trying to shift the paradigm from reactive medicine to proactive medicine and thinking about kind of a broad range of ways in which we can approach precursor disease. We're actively treating high-risk smoldering myeloma. We have a number of clinical trials in this area, ranging from something like Daratumab, Revlimid, Velcade, and dexamethasone, which is our standard of care for newly diagnosed myeloma patients, and exploring that in patients with high-risk smoldering disease, as well as taking our most exciting immunotherapies, our Bispecific T-cell Engager to Clistumab, and our CAR T-cell, Cilta cell, and using those in high-risk smoldering patients. So really exciting interventions in patients who are in that high-risk category, but beyond that in patients who have earlier stage disease, we're really interested in the role of lifestyle and modifiable risk factors for progression of disease. So we also have studies exploring things like prolonged overnight fasting, the use of metformin, really trying to think about the entire spectrum of precursor disease and how we can identify people who may be at higher risk, working on our risk stratification and prognostic indices, and then also trying to intervene. I think it's really exciting that we're in a position in this disease where we have such amazing drugs and have had such amazing drug development over the past decade that we can now start to think about how we cure patients and when and with whom we intervene. There are a lot of different types of fasting that you can read about, and with variable evidence prolonged. Overnight fasting is also known as time-restricted eating. So instead of going one day where you have a small window for eating and then another day where you have more unlimited, this is actually more of a lifestyle change where you have a window of at least 13, ideally 14 hours where you're not consuming food overnight. There are data in other diseases and in cardiovascular disease that this may be of benefit. I myself have studied this in breast cancer survivors, and we found that this was in 95% of patients doable, and there were benefits seen in things like fatigue as well, and this is in a breast cancer population. But we really want something when we think about how people can change their lifestyle that is doable for real world in a long-term fashion. And so this has some data behind it, and we're exploring both the feasibility and the effect that it might have on precursor disease. So we are actively enrolling. We put our first patients on beginning of March, so we don't have our data yet, but hopefully over the next year we'll fully accrue and be able to share that this time next year.