Ask the Expert about the Latest Myeloma News

Andrew Schorr:

Okay. Now let me just get your initial comment. So I have mention that this was sort of a pivotal time in myeloma with the amount of research and in some cases the quality of research that you and other practitioners have to go on. Where do you think we are? Are we at sort of a watershed time now in myeloma where really you have more information, more data, and more tools and that that's very encouraging?

Dr. Lonial:

Yes, I think you've summarized it really well. I think that it was pretty remarkable to see at this most recent American Society of Hematology meeting in December that there was an entire session dedicated to large, randomized, phase-III trials for newly diagnosed myeloma patients. I mean, that's unheard of to have that many trials to warrant its own session of presentations that were such high quality that they all deserved to be presented on the podium as opposed to in a poster format, and I think that in many ways that is a testament to the number of drugs that we have available. We have tools now that, you're right, we did not have even as recently as four and five years ago. It's also a testament to the collaborative nature of investigations in myeloma. I think that in the last four or five years now with drugs like Velcade, Revlimid, thalidomide and now Doxil all approved on the basis of large, 600-patient, randomized trials it really is a great testament to collaboration among investigators as well as patients to be enrolled and answer these important questions.

Andrew Schorr:

Now, of course, what happens in oncology then is as you have more tools then, it's a question of which drug or drug combinations, or if we have transplant as an approach too, which do you use when, and of course what frequency and what dosage, and if one approach doesn't work for a patient, what do you switch to? That will be a number of the questions we have. So, it sounds like it gets increasingly complex. Should a concern be for people listening worldwide, as it become more complex and maybe I'm treated by a community oncologist who has lots of other cancers to deal with, and hopefully things are happening there, how does anybody keep up? How can I make sure that the best thinking about myeloma and my myeloma situation is brought to bear? Any guidance there?

Dr. Lonial:

Yes, I think absolutely that that's a very challenging issue nowadays because with more data unfortunately we don't have more answers. What we have is more questions and more things that we want to find out about and answer and ask in terms of treatment options. I think that myeloma has become sufficiently confusing enough now that for every patient at some point in the course of their initial diagnostic workup that it would be reasonable for them to be seen at a large, tertiary myeloma center because I think what that offers you is a perspective from somebody who does in fact specialize in the care of that specific disease. It's not something that means that you're committed now to therapy forever from that tertiary center, which may be two hour, four hours, or six hours away from where you live. I think that the community oncologists are really quite good at delivering care, but I think because the questions have become confusing enough in terms of what's the best induction; what's the best workup for a newly diagnosed patient, is the FISH analysis being done in a good laboratory? That's enough up in the air that I think you want to be at a center where you have access to people who do this on a daily basis and let them help guide the therapy down the road that you can receive from your local oncologist.

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