Multiple Myeloma, Protease Inhibitor, Thalidomide discussed on Healthcare Triage Podcast
So when I started working on multiple myeloma, we had only this traditional chemotherapy in two thousand and three the first in class drug was approved which is a protease inhibitor and protease inhibitor is just thinking about it like a, you know, you have a garbage disposal, and you just clogging then you just accumulation of toxic stuff, and you know. The cells start dying. So that's how it works. And these are amazing. I mean, these drugs have changed the course of the disease now there are three drugs in that class available and in two thousand six we got a class of drugs approved called the immunomodulators drugs. So and the first in class was the drug thalidomide drug that cause a birth defect. When it was used in the fifties for motion sickness and nauseous associated with pregnancy and this drug we didn't understand how it works for a long time. But so and that but the problem was using thalidomide for a long time it can cause nerve damage. Okay. So the company that makes drug start developing next generation of that drugs that caused less neuropathy. We actually have to drugs in that class now. So we have three immunomodulating drugs three inhibitor. And then more recently the FDA approved drugs. We call him monoclonal antibody. So these are drugs that recognize the surface of myeloma cells, and sort of, you know, help eradicate these myeloma Celso protein that bind to the myeloma and bring immune cells to try to radically them Saturday decide which of those to us. Well, that's a great things. That's why we do clinical trial and in clinical trials, we find the best combination. So first of all we now know that one drug is not enough you have to use a cocktail of drugs. And so we just you know, the good things for patient today is that you have different cocktails so based on their medical condition, you can find the right combination therapy. So when you say their condition, what specific example, if somebody has significant nerve damage, you went to avoid drugs that cause further nerve damage if somebody have advanced kidney failure you and avoid the drugs that can be too toxic. If you have kidney failure. So that's a good news for the patient is that we can tailor. The therapy to were there conditions, and they're actually desire. I mean, some people would like only oral regimen. They don't wanna go to envision the can really go twice, you know, week to the clinic to get chemotherapy, we have oral regimens for them. So when you say they're cocktails a multiple drugs in a class or you're picking drugs from each different class. Exactly we pick drugs from different class. So basically what we do is synergy was at overlapping. Toxicity. Okay. And so what does the usual course, you have your dream Indra maintenance how to most patients too. So most people as I told you, you know, they really do. Well, they stay in remission for a long time. You know, now the average, you know, time in remission, maybe five to seven years, but unfortunately, we have these about twenty percent of patients who relapse was in the first two years, we call these are high risk risk of what risk of shorter remission shorter survival. That's where really a lot of research going on to try to improve the. Outcome of these patients. Do treat them again. Yes. Which read them again, we tried to find novel combinations. We tried to find clinical trials for these patients. We trying to employ some newer strategy. For example, one of the nearest strategy will be what we call Carty cells, which is basically taking the patient own immune cells expand them, genetically modify them to make sure that they can recognize myeloma and kill it. So we put to Sheen's one to recognize my Loma and one killer jeans. So that's why we call it kind Merrick receptor Antillean T-cells Carty cells. So these cells are I mean, these kind of therapy is now used and clinical trial in relapsed patients, but we may be able now to use it in a clinical trials for the higher spacious affront before they get to you know, relapse and have a horrible disease that how to control how hard is it to do that. So first of all you have to collect the patient and. T cells lymphocytes that become the killer cells. So basically, it's like we collect the stem cells. We do a free says we take the blood out separate the white cells from the rest of the blood..