There is much hype these days about genetic research and big data analyses. How do those approaches apply to myeloma? Are they the appropriate approaches for myeloma research?
In an article that has drawn much attention this week, science writer David Dobbs provides a careful analysis—a “state-of-the-art” assessment of the promises and failures of big genomic projects. The investments have been huge, he notes, but the health benefits unimpressive thus far. The progress has been complicated by a rush toward private investment with a view to future profits.
The key problem, especially for myeloma research, is that the gene abnormalities are very complex. There is no one simple test which can give the answer—nor is there likely to be. Myeloma cells have many, many mutations. Multiple genes are abnormal. In addition, we do not know which abnormalities are sustaining or promoting cancer growth. Even at the earliest stages of MGUS, multiple genetic abnormalities are often present.
The bottom line is that targeting a single genetic abnormality, for either diagnosis or treatment, is not an option at the present time. More work is needed to identify so-called “driving mutations”: one or more genetic abnormalities that have switched the myeloma cells to a cancer-growth pattern. Probing back earlier and earlier into the disease evolution is likely to give the best clues. The focus thus becomes potentially key mutations at the earliest time versus many, many mutations later in the disease course.
But such work takes time, and the expectation cannot be an investment with the goal of reaping large profits from new molecular targets for diagnosis and/or treatment. It is quite possible that prevention will be the only way to stop myeloma’s cascade of sequential clonal evolution that emerges once key mutations have occurred.
I certainly agree with David Dobbs that we do not want to pull the plug on big genomics, but we should strongly consider serious investment in other areas, such as prevention. What is it that causes myeloma? How can we reduce toxic exposures, change eating habits or other behaviors to reduce the risks? Worth thinking about.
So let’s keep all the options on the table, but be more aware of what is doable and what are realistic expectations moving forward.
Dr. Brian G.M. Durie serves as Chairman of the International Myeloma Foundation and serves on its Scientific Advisory Board. Additionally, he is Chairman of the IMF's International Myeloma Working Group, a consortium of nearly 200 myeloma experts from around the world. Dr. Durie also leads the IMF’s Black Swan Research Initiative®.