Wednesday, July 28, 2010

The Resistance Problem

I thought maybe I should attempt to clarify the resistance problem I mentioned in the previous post.

Unlike most of the more familiar types of cancer, multiple myeloma does not arise in a specific organ, but is systemic in nature. Even if, as in my case, there are tumors, there is no hope of chopping them out and then testing to see if you can convince yourself that you "got all the cancer". You can think of myeloma as being metastatic right out of the starting gate. The cancerous cells are white blood (plasma) cells, which are everywhere in the body. Furthermore, no known chemotherapy can be guaranteed to get all the cancerous plasma cells either; a few are bound to survive the encounter with the chemotherapeutic agent, and if they take it into their heads to begin multiplying, the patient is back where he began -- except that the previous "successful" therapy is no longer a viable option. At that point, the patient and his oncologist must shop for another therapeutic regimen to try.

Some myeloma patients experience this cycle of treatment, remission, and relapse many times. A good illustration of this is a recent Phase 2 clinical trial of Onyx Pharmaceuticals' carfilzomib, which is designed to add yet another option for this type of patient. The trial involved 266 "heavily pretreated advanced multiple myeloma patients". These patients had undergone a median 5 prior therapeutic regimens, involving a median 13 chemotherapeutic agents.

This isn't necessarily my fate. There are myeloma patients who survive many years on the same maintenance therapy, without disease progression. I'm keeping my fingers crossed.

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