Shedding light on the Multiple Myeloma research


Having been selected in 2015  among the world’s most influential scientific minds by Thomson Reuters, Dr. Athanasios-Meletios Dimopoulos, Rector of the National and Kapodistrian University of Athens and Professor of Hematolody-Oncology School of Medicine, has been dedicated to improve the life of the patients with Multiple Myeloma. Right from the beginning of his scientific career he sheds light through his world-recognized research on the second most common cancer of blood. While today a cure for it has not yet been discovered, Multiple Myeloma is increasingly becoming a manageable, chronic disease.

Dr. Dimopoulos, you were recently given by the IMS the Waldenström Award as recognition to your outstanding contribution to the Myeloma field. Could you please briefly refer to the latest advances over the last 2-3 years in this research field?

There have been major advances in the treatment of Myeloma. This change essentially started in 1999. At that time it was first reported that thalidomide – an immunomodulatory agent, which has been around for many many years- had activity in Myeloma. This triggered a lot of research and since then we have several agents that have been shown to have activity in Myeloma. More recently in the last two years, the major advance has been the use of monoclonal antibodies in Myeloma. First with elotuzumab, which showed a modest activity in combination with lenalidomide and dexamethasone and more recently with the anti-CD38 monoclonal antibodies and especially daratumumab. This is the major breakthrough over the last year in the field of Myeloma.

Coming to your individual role, in which way does your personal contribution enlighten our so far knowledge in the field of Multiple Myeloma?

 If we focus in the treatment aspect, I have been the principal investigator in the study which established the use of lenalidomide and dexamethasone in the treatment of Myeloma. This study was presented for the first time in 2005, it was published in the New England Journal of Medicine in 2007 and essentially since then lenalidomide and dexamethasone has been an important combination for the treatment of Myeloma.  Actually many other combinations have been shown activity when they add other agents to this lenalidomide and dexamethasone. More recently I was also involved in the establishment of Pomalidomide and low doze dexamethasone as an effective treatment of Myeloma and this trial, in which I was a co-primary investigator led to the approval of Pomalidomide and low dexamethasone. Very recently, in 2016, I was the principal investigator of the Pollux trial, which compared lenalidomide dexamethasone with or without daratumumab, the anti-CD38 monoclonal antibody in the treatment of relapse Myeloma. The study was published in the late 2016 in the New England Journal of Medicine.

 Could you briefly outline the positive effects of all this drug-development research to patients’ overall health?

 These new combinations are associated with a higher response rate, greater improvement of the symptoms of the disease, longer survival without disease progression and longer overall survival. In many patients with Myeloma, their disease is changing to a chronic condition. We believe, that in some patients the disease may be completely eradicated. Our aim is to constantly increase the number of patients in whom Myeloma will be eventually cured.

 About a month ago you became the Chairman of a recent Balkan initiative in Multiple Myeloma Treatment taken by the Plasma Cell Dyscrasias Unit of the Medical Faculty Therapeutic Clinic of the National University of Athens.  What are your expectations from this effort?  Are you going to raise awareness about it?

 You are absolutely right. The main idea behind this Balkan Myeloma Study group, which was established in late February 2017, at the first Assembly Meeting that we had in Belgrade, Servia, is first of all to evaluate the situation regarding the clinical and epidemiological features of Myeloma in Balkan countries including Turkey to see what are the treatments options for the patients in that area.  We also want to increase -as you mentioned- awareness about this disease and to promote the activation of clinical trials in all Balkan countries. As you already may know, whenever a clinical trial is activated in a country or in a center, then it provides the opportunity to patients to get treatment with innovative regiments that are not costing anything to the healthcare system of the country because they are provided for free by the respective pharmaceutical companies. So, I believe this is an important service to Myeloma patients throughout the Balkan region to activate these trials so that the can have access to novel therapies.

 My next question is about a big challenge in cancer field, the personalized treatment. How difficult is to optimize it for each patient?

 This is a key issue because in cancer now we have many therapies that it is very difficult to decide, which patient is likely to benefit from particular treatment or not. So, we need to develop markers to identify subset of patients who are likely to benefit or not. For example in some diseases such as non small Cell Lung Cancer, we know that for some patients, who experience a specific mutation there is a specific drug that is active versus inactivating the other patients. In Myeloma, at this point we are trying to identify such subsets but yet we cannot really select treatment based on the variables. But definitely, this is the way that this field will move in the coming years.

 To summarize, I would like to ask you if you are scientifically optimistic enough to even say that the developing knowledge in the area of hematological cancer will hopefully one day lead to future cures.

 The median survival of patients with Myeloma in early 1999 was about 3 years. Now if we take all patients with Myeloma, we believe that the median survival today is around 6-7 years. So, we already have doubled it. Furthermore, we know that there is an increasing number of patients with Myeloma, who are living for many years -more than 10- without evidence of disease progression. They respond to treatment and they stay with disease under control for a long time. So, potentially some of these patients will be cured. And we think and see that there is an increasing percentage of these patients, who achieve long term disease control. There has been a question: “What means to be cured from a disease such as Myeloma”, and one patient who was also a Physician replied that “cure is to live long enough and die of something else, not of Myeloma”. So, it is always relative. But if we succeed –let’s say to have most of our patients live for many years without signs of activity of the disease. We then can say that we have transformed Myeloma into a chronic disease and already there is a significant gain for our patients.

The interview was first published in Science View.