The use of new diagnostic technology has drastically changed clinicians’ understanding of the molecular drivers that underlie disease initiation and progression in multiple myeloma (MM). In a review published in Blood, researchers discussed how incorporating biomarkers into routine diagnostic workups of patients with MM may allow for the use of personalized treatment strategies and ultimately improve outcomes.
The authors examined the current use of prognostic and predictive biomarkers for treating MM and speculated on advances that may lead to further improvements in outcomes. In particular, the adoption of tabletop analyzers, mass spectrometry, next-generation flow cytometry, mass cytometry, and whole proteome analysis have allowed the study of the myeloma proteome. As data from genetic analyses becomes more mature, clinicians can adopt new clinical algorithms that incorporate not only clinical factors and comorbidities but also predictive biomarkers.
The authors highlighted 2 clinical algorithms that might improve outcomes. The first would target patients with high-risk markers using intensified therapeutic approaches such as quadruplet or quintuplet regimens and novel immunotherapy agents including antibody-drug conjugates and chimeric antigen receptor (CAR) T cells. The other algorithm would use molecularly targeted agents matched to the patient’s disease, a strategy that may help avoid unnecessary toxicities.
Combination approaches that include immunotherapies offer great potential for helping those patients who currently have the worst outcomes and highest unmet clinical need. However, there are still many unanswered questions. Clinicians lack evidence to help them decide how best to incorporate novel immunotherapy agents into treatment, and little is known about what treatment schedules and sequencing approaches are optimal with currently available agents.
“I think that although personalized medicine has potential, it is premature to say that it has already made a major [difference],” said Ravi Vij, MD, of the divisions of hematology and oncology at the Washington University School of Medicine in St. Louis, Missouri, in an interview with Hematology Advisor.
Luciano Costa, MD, PhD, of the division of hematology and oncology at the University of Alabama at Birmingham, agreed that the idea of personalized medicine is attractive but is currently not a reality for the majority of patients with MM.
“Even though great progress has been made in identifying biologic heterogeneity among cases of MM and separate subsets with distinct genetic alterations, that knowledge has not yet substantially affected how patients are treated. Some subsets are known to have a worse prognosis based on genetic changes, but data linking specific treatments to specific subset of patients are still lacking,” Dr Costa told Hematology Advisor.