Researchers and Advocates Make Progress in Multiple Myeloma
Brian Durie, MD, and Susan Novis, president of the International Myeloma Foundation, answer questions about the progress in multiple myeloma.
With his upcoming wedding, Brian Novis decided to increase his life insurance—a decision that required a simple blood test among other tests to gauge his physical well-being. The results showed multiple myeloma, a cancer of the bone marrow that produces too many abnormal plasma cells. And in 1988, the prognosis and treatment for multiple myeloma wasn't promising.
When he was diagnosed, Brian was told he had three to five years to live. He stayed busy during the next four years before his death in 1992. He married his fiance Susie and started the International Myeloma Foundation.
Susie remembers how Brian asked her carry on the foundation. "Brian said, 'You know Susie, one person can make a difference, two people can make a miracle.' " After her husband's death, Susie Novis made the foundation her own mission to educate patients and fund research.
Plasma cells are produced by the bone marrow, and for patients with multiple myeloma, these cells begin multiplying at an abnormal rate. The unhealthy plasma cells tend to crowd out other types of blood cells, including oxygen-carrying red blood cells and infection-fighting white blood cells, which can result in anemia and an increased risk of infection. Myeloma can also damage the kidneys and decalcify bones, making them weak and at increased risk of breaks and fractures.
The American Cancer Society estimates that in 2007 there will be approximately 19,000 new cases of multiple myeloma and 10,790 deaths in the United States. However, newer treatments, such as Thalomid® (thalidomide), Revlimid® (lenalidomide) and Velcade® (bortezomib), have shown benefit and are extending remission times and survival.
Approved in 2003, Velcade works by inhibiting proteasomes—enzyme molecules that act as a cellular garbage disposal, destroying damaged proteins. Researchers also believe it may inhibit a protein called nuclear factor kB, which is partly responsible for the process of stimulating growth and preventing cancer cell death. Revlimid and thalidomide kill myeloma cells by reducing blood vessel growth and angiogenesis in the bone marrow.
In 1988, the standard treatment for Brian Novis was steroids and chemotherapy, and little support or patient education available. In response, Brian and his doctor, Brian Durie, MD, started a foundation to reach out not only to patients, but also to doctors. Knowing he had limited time, Brian worked for the next two years developing a foundation and raising awareness of the disease.
Seventeen years after the International Myeloma Foundation was started, it has grown to include more than 165,000 members in 113 countries worldwide. Dr. Durie, an attending physician at Cedars-Sinai Medical Center in Los Angeles and National Program Director for Multiple Myeloma and Related Disorders at Aptium Oncology, and Susie Novis, now president and cofounder of the IMF, work collaboratively to educate newly diagnosed patients about the disease and to help them find effective treatments. Dr. Durie and Susie recently answered CURE's questions about the disease and recent advances in the field.
Q: Why has multiple myeloma been so hard to treat?