Keith Stewart, MB, ChB: Let’s move away from the economics for a second because it’s more cheerful to talk about other things. What do you hear from your patients, what are they looking for when they’re first diagnosed?
Mary E. DeRome: That is a time when it’s really important for patients to become as well educated as possible on their disease to help them achieve the best possible outcomes, right? So we’ve worked together in a collaborative effort with a number of other research foundations under this umbrella of the Harvard Business School with this Kraft Precision Medicine Accelerator. So the goal of that organization is to really define what the knowledge gaps are with patients, myeloma patients and other patients, cancer patients in general, actually, when they’re newly diagnosed and what do they need to do and what do they need to learn to assure that they’re going to have the best outcomes for their disease.
What we have come up with in this collaborative effort with the other research foundations is what we call the Right Track initiative where we encourage patients to first find the right care team, second, have the right testing done on their disease, third, get on the right treatment for their disease. And then across the board during all of their newly diagnosed phase, share their data with any organization, so that that data can go toward finding a cure. So, for myeloma specifically, it’s very important to find a care team that sees a lot of myeloma patients because we know that myeloma is a very heterogeneous disease and it’s very complicated. And it’s moving very quickly. There are a lot of new developments very rapidly.
So it’s important for patients to see a myeloma specialist, a hematologist-oncologist who sees a lot of patients who can help and really give them the best advice. They certainly can continue going to their community oncologist, but we encourage them to get a second opinion and to consult with a hematologist-oncologist at least once a year. And it’s also very important to get the right testing done because in myeloma, that will certainly help to determine what subtype your myeloma is, which will then inform the type of treatment that would be best for you at that stage of your disease.
Keith Stewart, MB, ChB: Thank you. Andrzej, myeloma is a long haul for many patients. We give them upfront therapy, but we do expect that they will need therapies in the future. How much does that feed into your treatment decision-making planning?
Andrzej Jakubowiak, MD, PhD: It is something that I discuss, and it’s probably the hardest part for patients to accept. They can potentially very easily accept the plan for induction, for example, or even consolidation if they are transplant candidates. The concept of prolonged treatment is more difficult to not only discuss but eventually to accept.
Keith Stewart, MB, ChB: Do you save drugs for later or do you use all your best drugs up front?
Andrzej Jakubowiak, MD, PhD: I use the best drugs up front, to directly answer this question. I think that the data support that. There are 2 key observations in recent years that I think are supporting that. Number 1) There was, starting from the FIRST trial but several other studies kept showing that if you stop treatment shorter than treating up to progression, you may harm the patients, at least the duration of remission. And number 2) It is important for outcome, statistically, it doesn’t always work for every patient, but it is important statistically to achieve deepest response. There is no question that the deepest response is providing statistically longer remission. And you combine this together because you cannot get to deepest response with short treatment.