Thanks to many new therapies, since the beginning of the 2000s the survival of the sick has been getting longer and longer. Other treatments are on the way, after completing the experimentation process. Bone pain, a symptom not to be overlooked
Doctors who treat cancer patients are by nature wary of talking about healing. Those who are expert and scrupulous are even more so, always looking for the correct balance between instilling courage and hope, without exceeding in false illusions. Oncologists and haematologists, used to living with the pain of many patients and family members, do not like the word «Revolution». Yet, they rarely use it: when the change is really great and the progress is both significant and scientifically proven. It happened recently, during the congress of the Italian Society of Hematology (SIE), when the progress made in the multiple myeloma therapy.
Of this blood cancer, diagnosed every year a about 5,700 people mostly over 70 years old, there was talk recently when the musician Giovanni Allevi announced that he suffers from it and that he has started a tiring process of treatment that will keep him away from the scene for a while. Many fans are wondering about the prospects for the care of the young pianist and composer. The good news is that they have improved a lot thanks to the steps forward that began in the 2000s, as he explains Michele Cabledirector of the Seràgnoli Institute of Hematology at the University of Bologna and IRCCS University Hospital of Bologna: «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 autologous stem cell transplantation (of the same patient) in “young people”, i.e. in those who were generally less than 65 years of age. The median survival was about three years in the first group and about five in the subjects undergoing transplantation. The disease was considered ineluctably fatal, above all because it always or almost always led to relapses”.
And now what is the situation?
«Since the beginning of the 2000s, the therapeutic approach has changed radically thanks to the availability of biological drugs, non-chemotherapy, such as immunomodulators, proteasome inhibitors and monoclonal antibodies – responds Cavo, member of the Sie board -. These drugs, combined with each other and on an ongoing basis, have significantly increased median survival which today exceeds seven years in “elderly” patients with newly diagnosed disease and is of over ten years in patients undergoing autologous transplantation. Of the latter, today, at least 30% are free from long-term disease progression. That is, albeit with caution, they can be considered “operatively” healed ».
What cures have arrived that have changed perspectives?
«Today we have available, already approved and used also in Italy, 20 different therapeutic regimens including new drugs belonging to the three main classes (i.e immunomodulators, proteasome inhibitors and “classical” monoclonal antibodies and conjugated with cytotoxic agents). They can be used both for those who have just received the diagnosis, and for those who have a relapsing or refractory disease (i.e. who resists treatment, ndr). All these medicines have allowed us to increase not only the response rate, i.e. the number of patients who benefit from the therapies (which reaches up to 90% and beyond), but also its “depth” (therefore the share of people without minimal residual disease is growing: that is, in the specific tests not even a single cancer cell is identified among 100,000-1 million normal cells, ndr) and to extend its duration”.
Bone pain is one of the most difficult symptoms for sufferers: why? What can be done?
«It is present in about two thirds of newly diagnosed patients, negatively impairs the quality of life and sometimes leads to bed rest. It is the result ofhyper-activity, caused by myeloma, of the cells responsible for the resorption of the bone matrix (osteoclasts) and the reduced activity of cells responsible for the synthesis of new bone (osteoblasts). It follows a loss of bone mass greatly exceeds its synthesis. Bisphosphonates, together with new drug therapies, rebalance this altered relationship by inhibiting osteoclast activity. Then, in particular cases, such as that of patients with vertebral collapses, it may be useful to evaluate with the orthopedic specialist the indication to perform vertebroplasty surgery».
Are there any other news on the horizon?
“New and more powerful immunomodulatory drugsdrugs with innovative mechanisms of action (such as, for example, exportin inhibitors), bispecific antibodies and CAR-T. Both for therapy with the patient’s T lymphocytes genetically modified to express a chimeric receptor directed with a plasma cell antigen (CAR-T), and for bispecific antibodies capable of redirecting the patient’s T lymphocytes near the tumor cells and selectively eliminating them , the authorization from the Italian Medicines Agency for reimbursement is awaited. The indication for 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 who are refractory to the last therapy received”.
What are the “alarm bells” not to be overlooked for an early diagnosis? What should worry?
«The painful symptomatology – concludes Cavo – does not affect the joints, while persistent or worsening bone pain, most often in a fixed locationmust take the patient to consult their trusted doctor who will evaluate the indication and recommend the execution of specific blood tests and radiological investigations. Of particular utility, computed axial tomography (Tac), or with positron emission (Pet), and nuclear magnetic resonance (Rmn)».
December 20, 2022 (change December 20, 2022 | 19:36)
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