For those suffering from blood cancer diagnosed by the musician Giovanni Allevi, with the arrival of new therapies, expectations have significantly improved. How to manage bone pain
Doctors who treat cancer patients are naturally wary of talking about healing. The expert and scrupulous ones are even more so, always looking for a correct balance between instilling courage and hope, without exceeding false illusions. Oncologists and hematologists, used to living with the pain of so many patients and family members, do not like speech Revolution. Yet, they rarely use it: when they really do the big change and the advances are both significant and scientifically proven. happened recently, during the congress of the Italian Society of Hematology (Sie)when it comes to the progress made in the multiple myeloma therapy. Of this blood neoplasm, diagnosed every year to about 5,700 Italians, mostly over 70, there was talk recently when the musician Giovanni Allevi communicated through social media that he suffered from it and that he had begun a tiring process of treatment that will keep him for a while. away from the scene.
Change of perspectives since 2000
Many fans are wondering what are the prospects for the care of the young pianist and composer. The good news is that they have improved a lot thanks to the advances started in the 2000s, as he explains Michele Cavo, director of the Sergnoli Institute of Hematology at the University of Bologna and IRCCS Bologna University Hospital: The therapy of the previous millennium used almost exclusively chemotherapy drugs (first of all melphalan), administered at low doses in “elderly” patients. Or in high doses, with subsequent stem cell transplant autologous (from the same patient) in the “young”, that is, in those who were generally less than 65 years of age. Median survival was about three years in the first group and about five in transplant recipients. The disease was believed to be inevitably fatal, mainly because always or almost always led to relapses.
What is the situation now?
Since the beginning of the 2000s, the therapeutic approach has radically changed thanks to availability of biological drugs, non-chemotherapy drugs, such as immunomodulators, proteasome inhibitors and monoclonal antibodies – says Cavo, member of the Sie board -. These drugs, combined with each other and continuously, have median survival considerably increased which today exceeds seven years in “elderly” patients with newly diagnosed disease and over 10 years in patients undergoing autologous transplantation. Of the latter, today, at least 30% are free from long-term disease progression. That is, albeit cautiouslycan be considered “Operationally” healed.
What treatments have you arrived that have changed perspectives?
Today we have available, already approved and used also in Italy, 20 different comprehensive therapy regimens of new drugs belonging to the three main classes (i.e. immunomodulators, proteasome inhibitors and “classic” monoclonal antibodies conjugated with cytotoxic agents). They can be used both for those who have just received the diagnosis and for those who have a relapsed or refractory disease (that is, which resists treatment, ndr). All these medicines have enabled us to not only increase the response ratethat is the number of patients who benefit from the therapies (which reaches up to 90% and more), but also its “depth” (therefore the share of people without minimal residual disease is growing: that is, in specific tests not even a single cancer cell is detected among 100 thousand – one million normal cells, ndr) and to extend its duration.
Are there any other news on the horizon?
New and more potent immunomodulating drugs, drugs with innovative mechanisms of action (such as, for example, exportin inhibitors), bispecific antibodies and CAR-T. Both for patient T cell therapy genetically modified to express a chimeric receptor directed with a plasma cell antigen (CAR-T) both for bispecific antibodies able to redirect the patient’s T lymphocytes near the tumor cells and to selectively eliminate them pending the authorization of the Italian Medicines Agency for reimbursement. The indication of use for both of these therapies will be aimed at the treatment of patients who have already received the three main classes of drugs and they are refractory to the last therapy received.
Bone pain: one of the hardest symptoms for patients
present in about two thirds of newly diagnosed patients, negatively alters the quality of life and sometimes leads to lodging. the result of the hyperactivity, caused by myeloma, of the cells responsible for the reabsorption of the bone matrix (osteoclasts) and of the reduced activity of the cells responsible for the synthesis of new bone (osteoblasts). One derives from it bone loss far exceeding its synthesis. THE bisphosphonates, together with therapies with new drugs, rebalance this altered relationship by inhibiting the activity of osteoclasts. Then, in special cases, such as that of patients with vertebral collapses, it may be useful to evaluate with the orthopedic specialist the indication to perform a vertebroplasty operation.
Alarm bells
What are the alarm bells not to be overlooked for an early diagnosis? What should you worry about? The painful symptomatology – concludes Cavo – does not affect the joints, while persistent or worsening bone pain, more often in a fixed locationthey must bring the patient to consult their doctor who will evaluate the indication to recommend the execution of specific blood tests and radiological investigations. Particularly useful are computerized axial tomography (CT) or positron emission tomography (PET) and nuclear magnetic resonance (NMR).
November 9, 2022 (change November 9, 2022 | 15:50)
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