Management of multiple myeloma: the impact of ixazomib’s approval in Canada

Donna E Reece from the Princess Margaret Hospital/University of Toronto (Canada) speaks to Laura Dormer, Commissioning Editor at Future Science Group (London, UK).

Could you briefly summarize your career path & how you came to work in your current role at Princess Margaret Hospital/University of Toronto?

I trained in the USA, at Baylor College of Medicine (TX, USA), then went on to complete a fellowship in hematology-oncology at Washington University in St Louis (MO, USA). For the past 30 years, I have primarily lived and worked in Canada, starting when I moved to Vancouver to help develop a bone marrow transplant program. At this time, bone marrow transplants began to emerge as a good treatment for myeloma, which piqued my interest in the disease. I worked in the bone marrow/stem cell transplantation field for 25 years, but really became involved in myeloma management when I moved to Princess Margaret Hospital/University of Toronto, which has a long legacy of myeloma research. Today, I have evolved into a full-time myeloma-focused doctor who still does stem cell transplants amid a number of other nontransplant therapies, including using exciting new drugs. It has not been the ‘usual’ path for a myeloma doctor, but has been a wonderful one. Autologous stem cell transplants continue to play an important role in the management of myeloma – a role that has not diminished over the last 20 years. Transplants were a key first step to improve disease management for myeloma patients historically, but there is now a pressing need for additional new drugs for use before and after relapse, and for any subsequent relapses.

What is the current standard of care for patients with relapsed &/or refractory multiple myeloma?

I informally use the term ‘early’ relapse to refer to a myeloma patient’s first or second relapse, and ‘advanced’ relapse when they have had recurrence three or more times. Most myeloma patients will receive three, four or even five lines of therapy before they unfortunately pass away from the disease. When explaining myeloma treatments to patients, I often refer to them as ‘beads on a chain’, with each treatment as a bead. We want each of those treatments to work as well as possible, for as long as possible and to be the least toxic. The ‘beads’ for ‘early’ relapse are different from those used for ‘advanced’ relapse. The disease becomes more stubborn – harder to treat and with shorter remission times – as subsequent relapses occur. There has been a tremendous amount of progress with options for first and second relapses. Often, particularly in the past, the standard-of-care in many jurisdictions has been the use of a two-drug regimen such as lenalidomide and dexamethasone in this setting. Other options are also available, including combinations of bortezomib, dexamethasone and perhaps another drug such as cyclophosphamide.

Click here to read the full article in the International Journal of Hematologic Oncology.