Equal Access to Multiple Myeloma Treatments Can Help Improve Survival Rates

Jennifer Flowers thought her pain and fatigue were a side effect of working out. Perhaps she’d pushed herself too hard or strained a muscle. But the pain persisted, so she scheduled an appointment with her doctor.  Her diagnosis—multiple myeloma, a type of blood cancer—was unexpected.     

“I was stunned,” Flowers says. “I’m a health-conscious professional and was exercising multiple times a week.”

Her first thought, Flowers says, was “How long do I have to live?”

Medical Innovations Extend Survival Rates

In 1998, the five-year survival rate for multiple myeloma was 34.6%. That means that approximately 35 of 100 people with the disease were alive five years after their diagnosis.¹ By the early 2000s, the median survival time was seven years, thanks largely to the introduction of autologous stem cell transplants (a procedure that uses a patient’s healthy blood stem cells to replace diseased bone marrow).²

Flowers, diagnosed in 2008, underwent a year of chemotherapy before receiving an autologous stem cell transplant in early 2010. Her cancer went into remission.

Meanwhile, survival rates continued to climb. Between 2010 and 2016, the five-year relative survival rate was 53.9%.³ By 2018, it was 57.9%, thanks in part to the development and approval of at least a dozen new treatment options.⁴

Relapses, however, remain common. “Each time the cancer comes back, the remission period gets shorter and the prognosis gets worse,” says Jeff Settleman, PhD, Chief Scientific Officer for Oncology Research and Development at Pfizer. “There’s still a significant unmet need in the patient population for better treatments.”

Racial Disparities Persist Despite Treatment Advances

To date, patients with multiple myeloma have not benefitted from treatments equally. African Americans are at increased risk. The disease is twice as common in the Black community compared to other ethnicities. It’s also twice as deadly in Black patients compared to white patients.⁵

Research suggests that disparities in healthcare access contribute to clinical disparities. Black patients tend to be more likely to receive care at community health centers. Meanwhile, white patients are more likely to receive care at academic medical centers, from providers that are familiar with clinical trials offering access to the latest treatment approaches.⁶

Black patients are 50% less likely to undergo stem cell transplantation than white patients. They’re also less likely to receive medications known to extend survival.⁷ However, a retrospective analysis of more than 12,000 patient records from the Veterans Affairs database showed that given equal access to new therapies and treatments, African Americans who are younger than 65 and have multiple myeloma can experience superior clinical outcomes to their white peers, with longer median survival times.⁸

Closing the Survival Gap

Equal access to new treatments may help close the survival gap. Researchers have discovered a protein, B-cell maturation antigen (BCMA), on the surface of the myeloma cells and created a bispecific antibody that can target that protein.⁹

“Bispecific antibodies can bind to two different things at the same time,” Settleman says. “One arm of the antibody can bind to BCMA and the other arm to a protein on the surface of immune cells.” Bringing the immune cells into proximity with the cancer, he says, allows them to destroy the myeloma cells.

Pfizer is developing a bispecific antibody that is currently under investigation for the treatment of relapsed/refractory multiple myeloma. “A top priority has been to make the pivotal study for this treatment (MagnetisMM-3) more accessible to all people with triple-class refractory multiple myeloma,” Settleman says.   To that end, Pfizer has offered travel assistance to U.S. participants—including transit, meals and lodging—for trial participants and supporting outreach efforts to historically marginalized communities.

“We’re working with patient advocacy groups and underrepresented professional and social organizations to establish partnerships and build trust at the local level,” Settleman says.

Additionally, Pfizer researchers have carefully monitored trial enrollment to ensure equitable representation.

Ongoing research and outreach are meaningful to Flowers, whose cancer remains in remission. “My biggest hope,” she says, “is that researchers develop therapies to thwart this treacherous disease.”

References       

1. Understanding Survival Statistics. Multiple Myeloma Research Foundation. https://themmrf.org/multiple-myeloma/prognosis/understanding-survival-statistics/ Accessed August 23, 2022.
2. Mahajan S, Tandon N, Kumar S. The evolution of stem-cell transplantation in multiple myeloma. Ther Adv Hematol. 2018 May;9(5):123-133. doi: 10.1177/2040620718761776. Published March 5, 2018. Accessed August 23, 2022.
3. Understanding Survival Statistics. Multiple Myeloma Research Foundation. https://themmrf.org/multiple-myeloma/prognosis/understanding-survival-statistics/ Accessed August 23, 2022.
4. Cancer Stat Facts: Myeloma. National Cancer Institute. https://seer.cancer.gov/statfacts/html/mulmy.html Accessed August 23, 2022.
5. Understanding Multiple Myeloma. Multiple Myeloma Research Foundation. https://themmrf.org/multiple-myeloma/ Accessed August 23, 2022.
6. What are Some Disparities in the Treatment and Care of Multiple Myeloma Patients? International Myeloma Foundation. https://www.myeloma.org/diversity/are-some-disparities-treatment-care-multiple-myeloma-patients Accessed August 23, 2022.
7. Multiple Myeloma in Black Patients. Multiple Myeloma Research Foundation. https://themmrf.org/multiple-myeloma/black-patients/ Accessed August 23, 2022.
8. Fillmore NR, Yellapragada SV, Ifeorah C, et al.With equal access, African American patients have superior survival compared to white patients with multiple myeloma: a VA study. Blood. 2019 Jun 13;133(24):2615-2618. doi: 10.1182/blood.2019000406. Published April 19, 2019. Accessed August 23, 2022.
9. Pfizer Presents First Data from Planned Interim Analysis of Pivotal Phase 2 MagnetisMM-3 Trial of BCMA-CD3 Bispecific Antibody … Under Investigation for Relapses/Refractory Multiple Myeloma. Pfizer. https://www.pfizer.com/news/announcements/pfizer-presents-first-data-planned-interim-analysis-pivotal-phase-2-magnetismm-3 Accessed August 23, 2022.