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October 2001 Volume 4, Issue 7:
Myeloma Research in the New Millenium
By Brian G.M. Durie, M.D.
What Should We Expect From the PRG Process?
10.01.01

In view of recent events in New York and Washington, D.C., it seems appropriate to quote from Sir Winston Churchill, whose famous World War II epithet was ?Never give up.? A great devotee of history, he also took pains to point out that those who do not heed the lessons of history are destined to repeat the same mistakes. In the wake of recent excitement about presentations to congress and public statements by Geraldine Ferraro, there was a sense that history was being made and that many millions of federal dollars may finally be directed towards myeloma research. But, what can history teach us about increased cancer research funding?

Unfortunately, the track record is not good. In 1971, President Richard Nixon declared War on Cancer. Congress passed the National Cancer Act in December of that year ? almost 30 years ago. Millions of dollars poured into cancer research. At the basic level, cancer-causing viruses were a major topic and the establishment of the cooperative groups, such as the South West Oncology Group (SWOG), was a major initiative at the clinical level. As co-chairman of the myeloma committee for SWOG in the 1970s and 80s, I well remember these halcyon days of research dollars. The viral research led into a complex area of retro-virology, oncogenes and molecular genetics, which was not immediately productive in terms of cancer treatment. The development of the Durie/Salmon Staging System was funding by N.C.I. in the setting of the new cooperative group structure, which facilitated staging and protocol treatment to evaluate new therapies. However, although many treatments were tested and results published, little headway occurred. The drugs were just not available to make a difference. The critical targets for potential new therapies had not been established. So what was missing? Mostly a lack of appreciation of the complexity of the problem. For each patient, multiple factors come together in a unique fashion to cause multiple myeloma. There is no single factor that is the sole critical target. Some have equated myeloma to having terrorists in your immune system. To extend the analogy with the most recent terrorist tragedies, everyone has become acutely aware of how difficult it is to root out and destroy scattered terrorists versus attacking a single government or group.

Detailed intelligence is required. Patience is needed. The full scope of myeloma as a disease needs to be determined. War is not a good environment to study the intricacies of the immune system in health versus myeloma. We need to take time to understand what creates and maintains a normal immune system. What leads to the break down in immunity as myeloma emerges?

In view of recent events in New York and Washington, D.C., it seems appropriate to quote from Sir Winston Churchill, whose famous World War II epithet was ?Never give up.? A great devotee of history, he also took pains to point out that those who do not heed the lessons of history are destined to repeat the same mistakes. In the wake of recent excitement about presentations to congress and public statements by Geraldine Ferraro, there was a sense that history was being made and that many millions of federal dollars may finally be directed towards myeloma research. But, what can history teach us about increased cancer research funding?

Unfortunately, the track record is not good. In 1971, President Richard Nixon declared War on Cancer. Congress passed the National Cancer Act in December of that year ? almost 30 years ago. Millions of dollars poured into cancer research. At the basic level, cancer-causing viruses were a major topic and the establishment of the cooperative groups, such as the South West Oncology Group (SWOG), was a major initiative at the clinical level. As co-chairman of the myeloma committee for SWOG in the 1970s and 80s, I well remember these halcyon days of research dollars. The viral research led into a complex area of retro-virology, oncogenes and molecular genetics, which was not immediately productive in terms of cancer treatment. The development of the Durie/Salmon Staging System was funding by N.C.I. in the setting of the new cooperative group structure, which facilitated staging and protocol treatment to evaluate new therapies. However, although many treatments were tested and results published, little headway occurred. The drugs were just not available to make a difference. The critical targets for potential new therapies had not been established. So what was missing? Mostly a lack of appreciation of the complexity of the problem. For each patient, multiple factors come together in a unique fashion to cause multiple myeloma. There is no single factor that is the sole critical target. Some have equated myeloma to having terrorists in your immune system. To extend the analogy with the most recent terrorist tragedies, everyone has become acutely aware of how difficult it is to root out and destroy scattered terrorists versus attacking a single government or group.

Detailed intelligence is required. Patience is needed. The full scope of myeloma as a disease needs to be determined. War is not a good environment to study the intricacies of the immune system in health versus myeloma. We need to take time to understand what creates and maintains a normal immune system. What leads to the break down in immunity as myeloma emerges?

As in the 1970s and 80s, it is too soon to expect that we have identified the best targets for potential treatment, far less the best treatments. Therefore, as we proceed with the PRG process, we need patience, hope and optimism in assessing the most fruitful areas for future research. New molecular tools are available. Myeloma can be classified at the molecular level and selective targets sought. We need to foster an environment in which serendipity can prevail and lead to important new observations. The use of Thalidomid? (thalidomide) emerged from such an environment. Aredia? (pamidronate) was developed from drugs added to toothpaste to reduce tooth decay. We need to learn much more about health as well as disease. We need to focus on early preventative strategies, as well as treatment. We need to look to improvements in the quality and length of life with myeloma while we search for a cure.

The IMF is committed to helping researchers in any practical way feasible. The second IMF Myeloma Think Tank will take place in 2002. Investigators will develop recommendations for research and initiate collaborative projects on molecular classification of myeloma, new treatments for bone disease and molecular targets for therapy. The prognostic factor initiative from Think Tank 2000 is already bearing fruit and we look forward to many more successful projects in the future. A coalition has developed between government, pharmaceutical and private funders such as the IMF, which will bring ever closer the time when there will be life without myeloma.

As in the 1970s and 80s, it is too soon to expect that we have identified the best targets for potential treatment, far less the best treatments. Therefore, as we proceed with the PRG process, we need patience, hope and optimism in assessing the most fruitful areas for future research. New molecular tools are available. Myeloma can be classified at the molecular level and selective targets sought. We need to foster an environment in which serendipity can prevail and lead to important new observations. The use of Thalidomid? (thalidomide) emerged from such an environment. Aredia? (pamidronate) was developed from drugs added to toothpaste to reduce tooth decay. We need to learn much more about health as well as disease. We need to focus on early preventative strategies, as well as treatment. We need to look to improvements in the quality and length of life with myeloma while we search for a cure.

The IMF is committed to helping researchers in any practical way feasible. The second IMF Myeloma Think Tank will take place in 2002. Investigators will develop recommendations for research and initiate collaborative projects on molecular classification of myeloma, new treatments for bone disease and molecular targets for therapy. The prognostic factor initiative from Think Tank 2000 is already bearing fruit and we look forward to many more successful projects in the future. A coalition has developed between government, pharmaceutical and private funders such as the IMF, which will bring ever closer the time when there will be life without myeloma.


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