Source: The Straits Times, 31 August 2016
Many blood cancers once seen as death sentences have been transformed into chronic illnesses – thanks to newer, more specialised treatments, and better access to the latest drugs through clinical trials. In its weekly series on cancer, The Straits Times turns the spotlight on multiple myeloma, lymphoma and leukaemia.
Professor Chng Wee Joo, who specialises in treating patients with multiple myeloma, has a growing problem that he is happy about.
His patients, who suffer from cancer of the blood, are living longer. Prof Chng and his colleagues now need to pay more attention to long-term issues like treatment costs and quality of life.
“Treatment is improving, and many patients are surviving longer with the condition,” said the director of the department of haematology-oncology at the National University Cancer Institute Singapore (NCIS).
“It’s like diabetes or high blood pressure – you can’t quite cure the condition, and you need to take medicine for a long period of time, but you can sort of live with the disease.”
In a healthy person, plasma cells in the blood produce antibodies that help fight infection. Myeloma, which is usually discovered in those aged around 65, occurs when these cells mutate.
A decade ago, someone diagnosed with the disease would have only three or four more years to live. Now the average patient lives 10 years post-diagnosis.
“But that brings a different set of problems,” Prof Chng said. “In the past… issues like cost of long-term treatment and quality of life were not really a problem.”
Newer, more specialised treatments that can help people live longer come with a prohibitive price tag. A 21/2-year course of drugs that can help someone live longer when they have run out of options can easily cost half a million dollars.
The solution, said Prof Chng, is to get patients to take part in drug trials. Far from becoming guinea pigs, patients get early access to the latest drugs on the market.
Prof Chng recalled one patient who was “running out of options”, but went into a year’s remission after joining a trial.
“During that year, he saw his older daughter get married and his younger daughter graduate,” he said. “He was still able to go back to work, so he had good quality of life as well.”
New drugs are also a big part of treatment options for Dr Michelle Poon, a senior consultant from the same department at NCIS.
Dr Poon specialises in treating lymphoma, which is by far the most common blood cancer in Singapore, with around 600 cases a year.
While patients with more aggressive forms of this disease may develop suspicious symptoms like lumps – usually at the lymph nodes – or night sweats, other symptoms may go unnoticed for years.
Options are limited for those for whom treatment does not work, even though this cancer is generally considered “highly curable”.
“Even though we say it’s very curable, there remains a small proportion who don’t respond so well,” Dr Poon said. “Those are the patients (for whom) new things need to be done, and other routes need to be explored to try and help them.”
In addition to developing new drugs, researchers are looking into ways of helping the body’s own immune system fight cancer.
This is also the case for medical research on leukaemia, another blood cancer which involves white blood cells.
While this cancer is less common in adults than in children, adults do not respond as well to treatment, said Dr Lim Zi Yi, a senior consultant in haematology at Parkway Cancer Centre, Mount Elizabeth Novena Hospital.
The standard treatment for this form of cancer still involves radiotherapy and chemotherapy. About 50 to 60 per cent of patients can be cured.
However, Dr Lim added that – as with lymphoma – immunotherapy is being held up as a treatment of the future, although it will not go into mainstream use anytime soon.
“This is a promising and exciting area of cancer research, but further research and refinement… will be required before it becomes widely available,” Dr Lim said.