Up to 50 per cent of patients with high-risk multiple myeloma experience a relapse less than three years after starting treatment, and their five-year survival rate stands at under 30 per cent, compared to 70 per cent for those with the standard-risk form, said Dr Sathish Kumar, Senior Consultant, Department of Haematology, Singapore General Hospital (SGH), a member of the SingHealth group.

To see what can be done to improve their chances of surviving the disease, Dr Kumar is leading a team of haematologists from SGH and the National University Cancer Institute Singapore (NCIS ) to study the efficacy of a different drug combination treatment.

“Central to the study is the idea that patients with high-risk myeloma need a more intensive treatment approach from the beginning. Another idea is that continued treatment ‘maintenance’ may be useful in patients who show even very small amounts of residual cancer after bone marrow transplantation,” he said.

The current standard treatment includes a combination of targeted therapy, steroids, optional chemotherapy, followed by an autologous stem cell transplant. Patients found to be unfit for bone marrow transplant will receive only chemotherapy.

Under the trial, patients follow the same treatment combination but the targeted drug used is a novel agent known as carfilzomib, instead of standard treatment drugs like bortezomib.

The US Food and Drug Administration allows carfilzomib to be given to patients suffering from a relapse of the disease but in Singapore, where it has yet to be approved for standard use, carfilzomib will be offered only to trial participants newly diagnosed with the disease.

“This is based on the fact that if the drug can be good at the time of relapse after having treatment, it’s likely to be more effective if we can use it from the beginning,” said Dr Kumar.

The drug, estimated to cost US$15,000 (about S$20,500) per month of treatment, has shown promise in treating high-risk myeloma. Moreover, it has few side effects and is well-tolerated by patients, meaning that patients are more likely to complete a full course.

Read on for more details of the joint SGH-NUS trial treatment process.

Ref. Q15