Scientists are developing a genetic test to determine if blood cancer drugs will work

• Blood cancer screening test finds 10% of people cannot be helped by life-saving lenalidomide
• Could save patients from unnecessary side effects like exhaustion and infection

Scientists have developed a test to identify which blood cancer patients will benefit the most from a drug that can prevent their cancer from coming back. The test, which looks for genetic clues in cancer cells, can identify the ten percent of patients who see little effect from life-saving lenalidomide.

It could spare them unnecessary side effects such as exhaustion, infections and a higher risk of other cancers, although experts need more data before they know if it’s safe to stop using. medication.

But it also helps identify patients who might need other drugs besides lenalidomide, and gives peace of mind to those who are most likely to benefit.

The test is so useful that experts are calling for it to be used to guide the treatment of the 6,000 Britons diagnosed with myeloma – a type of blood cancer – each year.

Many myeloma patients take lenalidomide for up to a decade to try to control their disease.

“For the most part the drug is well tolerated, but some suffer from side effects such as feeling tired or prone to infections,” says Dr Martin Kaiser, consultant haematologist and clinical researcher at the Institute of Cancer Research in London. .

“Some take it up to a decade. A common question they ask is “Do I really have to keep taking this medication?” and ‘How much does this actually help me?’ ‘

Some studies have shown that taking the drug for a long time may be associated with an increased risk of certain cancers, including Hodgkin’s lymphoma. Myeloma affects a type of blood cells called plasma cells that help fight infections and are made in the bone marrow – the spongy tissue in the center of bones.

It causes plasma cells to overgrow, producing a buildup of defective cells in the bone marrow, which can damage bones.

It also disrupts the production of other blood cells, preventing the body from fighting infection effectively. The disease is sometimes called multiple myeloma because it affects the bone marrow in several areas, such as the spine and ribs.

To treat myeloma, chemotherapy and steroids are given to kill the defective cells, but the vast majority of patients will see the disease return within a few years.

Lenalidomide blocks the growth of abnormal cells, keeping cancer at bay for about three years on average, compared to two years without treatment. “But there are huge variations – for some it’s a decade, for others a year,” says Professor Kaiser.

Previously, there was no way of knowing who wouldn’t respond to the drug. But the study identified a group of “super-responders”, who are 40 times more likely to have their cancer stop growing than others.

In the study, researchers from the Cancer Research Institute and the University of Leeds performed the new test on 556 patients with newly diagnosed myeloma. It involves taking a sample of bone marrow tissue using a needle from the back, under local anesthesia, and looking for patterns in the DNA of the cancer.

Scientists found that a third of patients with a particular pattern lived on average just under five years on lenalidomide, compared to an average of around three years. Meanwhile, around one in ten with another genetic profile did not benefit as much – with results similar to those not taking lenalidomide.

“We are testing new drug combinations for this group that are found to be beneficial,” says Dr. Kaiser. “Those who may not be as likely to benefit can consider options such as clinical trials testing new drug combinations.”

Experts say it would be possible to use the test in this way, as it is already widely available in the NHS. ‘Many specialists use it after diagnosis to give patients an idea of ​​how aggressive the cancer is,’ says Professor Kaiser. “It helps us to better advise patients regarding their treatment.”

Cecelia Brunott, 46, from Surrey, was diagnosed with myeloma in 2020 and has been taking lenalidomide since September 2021, following a bone marrow transplant.

She volunteered to have the test and the results showed that her cancer was not genetically high risk.

“My cancer protein levels have gone down since I’ve been on lenalidomide and are no longer measurable,” she says. “The test gave me peace of mind knowing that the drug is helping ward off the cancer for as long as possible.”