18th Congress of EHA
An update from Myeloma UK
Eric Low - CEO, Myeloma UK
What interesting new data has been presented at the 2013 EHA meeting on multiple myeloma?
Lots of really interesting things from a Myeloma UK perspective. In terms of the talks and the data that has been presented there are lots of exciting things happening, lots of progression, even from ASH, in terms of data on all the key pipeline drugs that are coming through for myeloma. Particularly the poma data is most exciting and because we’re on the cusp of approval in Europe for poma as well, I think that’s been the most exciting thing at this conference. In addition to that, as well, is the scientific papers and talks on, for example, the genetics and clonal evolution. Even from the recent meeting in Kyoto you can see changes in thinking and refinement of ideas in that very short space of time. So it’s super-exciting, it’s tantalising what we might see at ASH and, from a patient perspective, it’s a good time for myeloma, we can see the progression from meeting to meeting. So it’s fantastic.
What will the approval of pomalidomide mean for MM patients in the UK?
Pomalidomide, we’ve been watching the development of pomalidomide carefully almost for ten years because, as everybody knows, it’s not a new drug. It was developed a long time ago at the same time as lenalidomide but the company brought lenalidomide to the market first. A lot of the doctors that had been involved in that research were quite frustrated because they felt that the other drug was better but for commercial reasons lenalidomide was brought forward. And that was fantastic because that is also a great drug and has really transformed myeloma treatment. So here we are, ten years later, to be on the cusp of getting pomalidomide is super-exciting for patients, particularly because the whole way through clinicians have been more excited about that drug than probably any other drug that has been in development for myeloma.
What’s this going to mean to the patients who are going to benefit?
I think there are a couple of things that are really critical. Because we know that myeloma is a relapsing remitting cancer it will always come back. Right now we don’t have a licensed treatment for double refractory myeloma in the UK or in Europe. So these are patients who have benefitted from all the other treatments and otherwise are quite well but have a fairly evolved clone so unless they have a good treatment option their survival could be measured in months. So pomalidomide is coming at exactly the right time in history, as it were, to capture these patients that have already had Velcade, that have already had thalidomide, they’ll already have had lenalidomide and possibly other drugs in clinical studies and can now get additional benefit from pomalidomide. The challenge is going to be around reimbursement because that is a fairly advanced group of patients and even though pomalidomide can extend survival fairly well, overall survival is still poor. So we’re going to have a very expensive drug for modest benefit so the major barrier is going to be around reimbursement. The UK has evolved to be a much better place for reimbursement; I think it has had its issues in the past but I think we’ve worked through that and I think the UK is a good place for reimbursement now. We have the tools to get it over the line but we do have some concerns for other regions in Europe who, frankly, at the moment are struggling to get thalidomide and even lenalidomide and here we have pomalidomide. So I think what we’ve got to do is to think carefully and be measured about our excitement over the launch of a new drug and think carefully about how we can get the maximum number of patients to benefit in that very difficult double refractory setting.
What significant changes have been seen in the management of MM and how might these influence treatment of UK patients in the future?
Again there are a couple of things. One is around the UK has become a little bit more competitive globally and a little bit more collaborative in early phase development of studies. Now, a lot of that has been led by Gareth Morgan, Faith Davis and others, there’s a good bunch of doctors supporting them too. So when we come to these meetings we always have a dozen meetings with drug companies around trying to encourage them to come to the UK and do clinical studies and improve access, think about how we can collaborate in terms of additional evidence development to help with the HTA hurdle. We’ve made significant progress at this meeting, we’ve had some really fantastic discussions with industry that I’m fairly certain will lead to clinical trial collaborations in the UK which is great from a UK perspective.
The other thing that is really important is that there is much more discussion around patient perspective, what do patients value, patient advocacy. And incrementally, every conference you go to now, that patient perspective is much more visible and we’re beginning to realise that there is a second translational element to development. It’s not just from lab to clinic or lab to trials, it’s from how do you take that data and translate that into clinical practice. One of the key things we’ve forgotten about is do we have the data to show what does that drug mean for patients. We know what it means in terms of PFS or OS but can we describe what value a patient would attribute to that drug with empirical evidence and we haven’t done that, we don’t have that data. But now everybody is beginning to work together and understand that we need this very important additional bit of data to help understand what the value of that innovation is to patients in real life.
How will personalised medicine influence MM patient management?
From our perspective stratified medicine is the way forward. I think the reality will be much more complex than the theory in terms of how we deliver it and we have to do it in a stepwise process. So it starts with science, having a good understanding of the biology, having good tissues samples, making sure that early development works well. But we’ve also got to have the diagnostic and screening capability and we need to understand the extent to which the market will value that type of innovation. If we don’t know that at the outset it would be high risk to develop strategies for smaller groups of patients at high cost. So I think it’s very exciting in theory but it’s the classic example of where we have to work from bench to bedside and bedside to bench right from the outset and engage everybody in the stepwise process of how we’re going to deliver stratified medicine into the clinic. Because I fear that the science will move faster than the ability of the downstream environment in terms of its ability to adopt and diffuse stratified medicine into the system. I think that’s where organisations like Myeloma UK can come in because we’ve developed a bedside to bench and bench to bedside strategy so we can map the whole development process and partner with regulators, industry, doctors and payers the whole way through the system to make sure we move forward in a stepwise and informed way and try and understand how the market will respond in terms of its willingness to pay for stratified medicine.