Taking part in a clinical trial may be the best treatment choice for some myeloma patients. Clinical trials are under way to develop treatments that increase the remission rate of myeloma or cure the disease. Today's standard treatments for cancer are based on earlier clinical trials. The Leukemia & Lymphoma Society (LLS) continues to invest funds in myeloma research.
Clinical trials can involve new drugs, new combinations of drugs or approved drugs being studied to treat patients in new ways such as new drug doses or new schedules to administer the drugs. Clinical trials are conducted worldwide under rigorous guidelines to help doctors find out whether new cancer treatments are safe and effective or better than the standard treatment.
Current Myeloma Research and Clinical Trials
Below are some types of research and clinical trials under way:
Drugs and Drug Combinations
Recent advances in the treatment of myeloma have resulted in improved response rates and overall survival in newly diagnosed patients and patients with relapsed myeloma. Eventually, however, nearly all patients experience a relapse of their illness because myeloma cells become resistant with time to current drug therapies. This means there is a continuing role for the introduction of investigational agents that overcome drug resistance. Several new approaches, including combination therapies to counteract drug resistance, are being studied in clinical trials for initial treatment and for the treatment of relapsed or refractory myeloma. Some examples are:
- Elotuzumab (HuLuc63). A monoclonal antibody that targets proteins on the surface of myeloma cells. It is being studied in combination with either Velcade® or Revlimid®, plus low-dose dexamethasone.
- Daratumumab (HuMax®-CD38). A monoclonal antibody that targets proteins on the surface of myeloma cells. It is being studied as a single agent, and in combination with either Velcade or Revlimid, plus low-dose dexamethasone.
- Ixazomib (MLN9708). An oral proteasome inhibitor being studied with Revlimid and dexamethasone versus placebo plus Revlimid and dexamethasone for relapsed/refractory and also newly diagnosed myeloma patients.
Stem Cell Transplantation
A number of approaches are under study, including:
- Allogeneic stem cell transplantation. A treatment for certain other types of blood cancers, it is being studied as a treatment for younger myeloma patients with high-risk disease. Allogeneic stem cell transplantation is associated with a higher risk for serious side effects and death compared to the risks associated with autologous transplantation. It may be considered for a patient who has an HLA [human leukocyte-associated antigen(s)]-matched donor, usually a brother or sister; other eligibility factors include patient age and the absence of certain medical conditions such as diabetes, kidney disease or heart disease. Two key potential advantages of this procedure are that using cells from a healthy donor rather than from the patient eliminates the chance that myeloma cells will be re-infused into the patient, and donor cells may also work as immunotherapy, providing an antimyeloma effect.
For more information about all types of stem cell transplantation, see the free LLS information booklet, Blood and Marrow Stem Cell Transplantation.
Various forms of immunotherapy are being studied, including:
- Vaccines. Proteins on the surface of myeloma cells may be especially well-suited targets for attack by vaccines, which could help the patient’s immune cells to attack his or her own myeloma cells.
- Antibodies. Drugs such as daratumumab and elotuzumab are immunotherapies because they work in part by making myeloma cells more visible to the patient’s immune system for attack. Other antibodies are being studied as well, including some that target programmed death ligand 1 (PD-L1) or its receptor, programmed death 1 (PD-1). This approach may reduce the immune suppression caused by myeloma and free the immune system to be more effective.
- Chimeric antigen receptor (CAR) cells. These are either T cells from the patient or natural killer (NK) cells from the patient or another donor which are altered so that they can more easily find and attack myeloma cells.
See the free LLS information booklet Immunotherapy Facts for information about the development of blood cancer vaccines.