The evolving role of novel and next generation therapies in the management of multiple myeloma: introduction and current therapies 1

Published on June 30, 2019   37 min

Other Talks in the Category: Genetics & Epigenetics

0:00
Hello. My name is Dr. Paul Richardson. I'm the RJ Corman Professor of Medicine at Harvard Medical School, and I serve as the Clinical Program Leader and Director of Clinical Research at the Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute in Boston, Massachusetts. It's my pleasure to talk to you today about the evolving role of novel and next-generation therapies in multiple myeloma and to share with you today current status and future directions in our field.
0:27
First, I want to show you my next slide, which simply is disclosures. These are my relevant disclosures to the discussion today and reflect my service on advisory committees, as well as research funding.
0:40
Now, in the context of multiple myeloma it's important to recognize that this is not just one disease. Clearly, multiple myeloma as it sounds is many different diseases. There's enormous variance between patients and, in fact, within a patient, disease can change over time. This recognition of what we call clonal heterogeneity has been essential in our understanding of what we call risk stratification. Fortunately, with the advent of novel therapies over the last three decades, there's been an ability to individualize treatment.
1:12
So as we consider the complexity of multiple myeloma biology, it's very important to appreciate that not only is multiple myeloma truly multiple and what that means is very traumatically between patients, but it's also important to appreciate that it varies and ebbs and flows and changes within a patient during the course of the natural history of the disease, and in this slide I seek to capture that by illustrating to you the clonal evolution and the matched genetic events that myeloma evolves from its precursor states of MGUS and smoldering disease to active disease and then to its relapsed refractory form. Then the far right of the slide, I really wanted to emphasize here, and I think quite seminal work from my colleague Dr. Nikhil Munshi looking at whole genome sequencing in the top slide of one of our patient's diagnosis. As you can see, there are 5,000 mutations in this patient's disease at that time. This patient then undergoes induction remission treatment, autologous transplant, consolidation, and maintenance and then relapses. As you can see in the bottom slide, at relapse, the patient is challenged by 12,000 mutations in his disease. This I think points to the extraordinary mutagenic thrust of this illness and how we need to understand better all the clinical implications of such genetic instability and what that means for a patient over time, especially as we now blessed fortunately with multiple new treatments and modalities that can hopefully improve outcome.
Hide

The evolving role of novel and next generation therapies in the management of multiple myeloma: introduction and current therapies 1

Embed in course/own notes