Are we ready for mutational directed treatment: addressing the genomic basis of myeloma

Gareth Morgan, MD, FRCP, FRCPath, PhD of the UAMS Myeloma Institute, Little Rock, AR is joined by Hervé Avet-Loiseau, MD, PhD from the University Hospital Toulouse, Toulouse, France to discuss the genomic basis of myeloma and mutational-directed treatment at the 2016 European Multiple Myeloma Academy (EMMA) held in Madrid, Spain. Prof. Avet-Loiseau begins by detailing the take away messages of the session on myeloma genetics. These include the heterogeneous nature of myeloma genetics and how they are targeted by drugs, and the use of next-generation sequencing (NGS) and interphase fluorescent in situ hybridisation (iFISH) in the clinic. Prof. Avet-Loiseau discusses the idea that high-risk patients need to be treated differently from the standard and describes a future trial planned with the IFM, which will focus on high-risk patients. Prof. Morgan and Prof. Avet-Loiseau then discuss what genetic lesions mean in MGUS and smouldering myeloma. The two physicians go on to discuss the new myeloma criteria routinely in their practice and agree that some aspects are questionable from a clinical perspective. To end the discussion, Prof. Morgan asks Prof. Avet-Loiseau if we should we be using genomic directed treatment, to which he says that genomic-directed treatments are popular in solid-tumour cancers and there are good responses seen in myeloma. However, it is sometimes the case that a mutation is subclonal so the treatment is not as effective. Prof. Avet-Loiseau believes that targeted therapy is the way forward; however, care needs to be taken in choosing patients for treatment.

This programme has been supported by Celgene and Amgen through an unrestricted educational grant to the Video Journal of Hematological Oncology.

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