Myeloma 2016: Panel discussion on the status of genomics

Chng Wee Joo, MB, ChB, PhD, FRCP, FRCPath, FAMS from the National University Cancer Institute, Singapore discusses the current status of genomics in multiple myeloma (MM) at the Myeloma 2016 meeting in Boston, MA with Gareth Morgan, MD, FRCP, FRCPath, PhD of the UAMS Myeloma Institute, Little Rock, AR and Michele Cavo, MD from the University of Bologna, Bologna, Italy. First, they discuss how the data on genomics in MM might be used in clinical practice. According to Prof Morgan, it has implications for treatment as it shows the need to use combinations of drugs to overcome interclonal heterogeneity. Also, if a mutation test is done, it might show different results at different sites, i.e. response might not be seen on all sites with targeted treatments. According to Prof Morgan it is clear that RAS and BRAF are key drivers of the diseases; if you target BRAF the tumor cells will die but there are differential responses, which, again, means that combinations of drugs need to be used. Further, he argues that umbrella study designs should be used to investigate what happens in depth, which will allow for better treatment decisions. Prof Cavo talks about how the understanding of p53 is still evolving and why prospective clinical trials for high-risk patients are needed. Prof Morgan explains how loss of 17p is not a good marker for high risk and why a better biomarker is needed when designing studies. In fact, the conflicting results obtained using bortezomib may be related to the different molecular phenotypes of patients according to Prof Cavo. They discuss the question of how to use genomics to better define high-risk patients. Prof Morgan highlights how 30% of patients are high-risk but GP-70 will identify only 15% of patients. It is therefore important to apply a concerted genomics approach, rather than focusing on single genes. Finally, Prof Cavo and Prof Morgan discuss how the future will be based on next-generation sequencing (NGS) and other approaches, such as FISH analysis, will be abandoned.

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