Scientists have developed a test to identify which blood cancer patients will benefit most from a drug that can prevent their cancer from coming back. The test, which looks for genetic clues in cancer cells, can identify the 10 percent of patients who see little effect from the lifesaving lenalidomide.
This could save them unnecessary side effects such as exhaustion, infections and an increased risk of other cancers, although experts need more data before they know if it’s safe to stop using the drug.
But it also helps identify patients who may need drugs other than lenalidomide, and reassures those most likely to benefit.
The test is so useful that experts call for it to be used to guide the treatment of the 6,000 Britons diagnosed with myeloma, a type of blood cancer, each year.
Many myeloma patients take lenalidomide for up to a decade to try to keep the disease under control.
Scientists have developed a test to identify which blood cancer patients will benefit most from a drug that can prevent their cancer from coming back (file photo)
“For most, the drug is well tolerated, but some experience side effects such as feeling tired or being prone to infection,” says Dr. Martin Kaiser, a consultant haematologist and clinical scientist at the Institute for Cancer Research London.
“Some take it for up to a decade. A common question they ask is ‘Do I really have to keep taking this medication?’ and ‘How much is it really helping me?’ ‘
Some studies have shown that taking the drug for a long time may be associated with an increased risk of some types of cancer, including Hodgkin lymphoma. Myeloma affects a type of blood cells called plasma cells that help fight infection and are made in the bone marrow, the spongy tissue in the center of bones.
It causes plasma cells to multiply excessively, leading to a buildup of defective cells in the bone marrow, which can damage the bones.
This also disrupts the production of other blood cells, preventing the body from effectively fighting infection. The disease is sometimes called multiple myeloma because it affects the bone marrow in several areas, such as the spine and ribs.
To treat myeloma, chemotherapy and steroids are given to kill the defective cells, but the vast majority of patients will see the disease return within a few years.
Lenalidomide blocks the growth of abnormal cells, keeping cancer at bay for about three years on average, compared to two years without treatment. “But there is a wide variation: for some it is a decade, for others a year,” says Professor Kaiser.
Previously, there was no way of knowing who would not respond to the drug. But the study has identified a group of ‘super responders’, who are 40 times more likely to have their cancer stop growing than others.
In the study, researchers from the Institute for Cancer Research and the University of Leeds performed the new test on 556 newly diagnosed myeloma patients. It involves taking a sample of bone marrow tissue through a needle in the back, under local anesthesia, and looking for patterns in the cancer’s DNA.
The scientists found that a third of patients with a particular pattern lived an average of just under five years on lenalidomide, compared with an average of around three. Meanwhile, about one in 10 with another genetic pattern did not benefit as much, with results similar to those not taking lenalidomide.
“We are testing new drug combinations for this group that are proving beneficial,” says Dr. Kaiser. “Those who are not as likely to benefit may consider options such as clinical trials that test new drug combinations.”
The test, which looks for genetic clues in cancer cells, can identify the 10 percent of patients who see little effect from the lifesaving lenalidomide. This could save them from unnecessary side effects, such as exhaustion, infections and an increased risk of other cancers (file photo)
Experts say it would be feasible to use the test in this way, because it is already widely available on the NHS. “Many specialists use it after diagnosis to give patients an idea of how aggressive the cancer is,” says Professor Kaiser. “It helps us better advise patients when it comes to their treatment.”
Cecelia Brunott, 46, from Surrey, was diagnosed with myeloma in 2020 and has been taking lenalidomide since September 2021, following a bone marrow transplant.
She volunteered to be tested and the results showed that her cancer was not genetically high risk.
“My cancer protein levels have dropped since taking lenalidomide and are no longer measurable,” he says. “The trial has given me the peace of mind that the drug is helping to keep cancer away for as long as possible.”