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The Black Swan Approach, or Cure = MC5
By Brian G.M. Durie, MD
For the International Myeloma Working Group, the search to find a cure requires a very straightforward equation: Cure = MC5. M=myeloma. But what is C5? It is the courage, commitment, creativity, compassion, and collaboration (C5) that are necessary to bring new ideas forward – it’s the smartest experts and researchers on the planet coming together to collaborate, not compete, on their new ideas, research data and more.
06.20.11

Cancer is a constant in the news. Just this month we’ve seen TIME Magazine’s Special Report on Health and reports from the recent American Society of Clinical Oncology meeting. Myeloma, a type of bone cancer, is mostly not in the news, unless a well-known figure is involved. Recently it was reported that Matt Damon’s father has myeloma and is fortunately doing well with treatment. But others, like Peter Boyle, Roy Scheider and Geraldine Ferraro, have sadly lost their battles. So how can we fight myeloma and other cancers, and where are we in the search for a cure?

In many ways, searching for a cure for any cancer is like an investor searching for the next Google, and finding this needle in the haystack requires using what philosopher and essayist Nassim Taleb calls "the Black Swan approach." As Taleb points out, one must be open to the "highly improbable," and he sites as an example the mistaken belief that swans could only be white, which was proved false after someone went to Australia and discovered black ones.

The lesson here is that it’s important to explore unknown entities and possibilities, and in the case of cancer, this means expanding upon the novel therapy approaches introduced by several biotech companies in the last decade. For myeloma, thalidomide and Revlimid® (lenalidomide), introduced by Celgene Pharmaceuticals, and Velcade® (bortezomib) by Millennium Pharmaceuticals (MPI) provide new possibilities for extended well-tolerated disease control. Variations on these drugs and agents synergistic with them – enhancing their efficacy – can provide benefits not thought possible.

Indeed, finding a cure will require the exploration of untested ideas – ideas that at the outset are "highly improbable." With this in mind, the International Myeloma Working Group (IMWG), the research division of the International Myeloma Foundation, annually brings together its members comprised of 145 of the top myeloma experts in the world to lead global dialogue on multiple myeloma research. Their goal is to collaborate in order to accelerate the development, clinical testing and approval for use of new treatments.

For the IMWG, the search to find a cure requires a very straightforward equation: Cure = MC5. M=myeloma. But what is C5? It is the courage, commitment, creativity, compassion, and collaboration (C5) that are necessary to bring new ideas forward – it’s the smartest experts and researchers on the planet coming together to collaborate, not compete, on their new ideas, research data and more.

At the IMWG’s recent Summit, participants discussed which patients are most likely to be cured (those with better risk features and earlier disease) as well as the testing needed to identify them. New combinations of available drugs were discussed. And most importantly, the potential for the "highly improbable" was also reviewed – and the result was legendary.

Dr. Stephen Russell from the Mayo Clinic presented his results with "oncolytic virotherapy," a new approach that could provide a "single-shot cure for myeloma." Dr. Russell’s technique uses viruses to attack myeloma cells wherever they might be throughout the body. You may be saying to yourself, "Really?! Is that possible?" Well, in mice, one injection of a targeted vesicular stomatitis virus (VSV-IFNβ-NIS) did provide a cure. Further work is still needed to bring this approach to the clinic so we can assess its benefit in myeloma and other cancer patients – but it’s a significant start.

This brainstorming effort continued in London as the experts broke into six groups to consider the different aspects of the search for better therapies, with special emphasis on potential new collaborations. Recommendations and protocols were established for the myeloma community as well as top-line ideas for funding and research collaborations. Research projects and clinical trials emerged from the Summit meeting last year in Barcelona. The newly formed Asian Myeloma Network--myeloma researchers from seven Asian regions—met for the first time at this Summit, and they are now able to expand the enormous impact they can have.

From this year’s London IMWG Summit, expectations are high that the C5 approach will be fruitful in a variety of ways, some, perhaps, "highly improbable." But that’s the point. Polio, small pox and diphtheria were all once thought incurable. Just in our lifetimes, chicken pox has gone from an inevitable childhood misery to purely preventable. Those of us who donned gloves to avoid scratching our blisters couldn’t imagine a single injection could make our illness obsolete.

The search for the cure moves ever forward.


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