Creating a Better Understanding of Multiple Myeloma

(Content sponsored by Sanofi)

Black Americans have become acutely accustomed to knowing the illnesses that affect us the most.

From diabetes, to high blood pressure, to heart disease, to breast and prostate cancer; we have a pretty good understanding of what ailments affect us more or are most likely to lead to mortality.

But what about multiple myeloma? Did you know that multiple myeloma is the most common blood cancer in Black Americans?¹

Did you know that Black men and women are diagnosed 2.5 and 3.5 times more under the age of 50 than their white counterparts?² These facts should make you sit up, take notice, and add multiple myeloma to the list of “Black illnesses.”

What is Multiple Myeloma (MM)? Multiple myeloma is a cancer of plasma cells, which are types of white blood cells found in the bone marrow that grow uncontrollably and crowd the normal plasma cells in the bone marrow.³

It is the second most common blood cancer in the world³ – falling into the same category as leukemia and lymphoma.

This debilitating disease affects more than 130,000 patients in the United States alone, with approximately 32,000 Americans diagnosed with multiple myeloma each year.⁴

Not all patients experience visible signs of multiple myeloma.⁵ However, some early signs and symptoms can include:

Bone pain that is persistent or recurrent, and fractures⁵
Persistent weakness due to anemia or kidney failure⁵
Recurrent unexplained infections, such as pneumonia⁵
Nervous system disorders⁵
Shortness of breath caused by heart or kidney failure⁵

Now, you could be saying, “That’s not a lot of people.” Yes, while multiple myeloma may appear to be a relatively rare disease that only accounts for a small percentage of all cancers, it is the most common blood cancer in Black Americans.¹ Additionally, despite treatment advancements, survival rates for Black American multiple myeloma patients have not been in lockstep with survival rates of other multiple myeloma patient populations.⁶

Dr. Tondre Buck of the Gibbs Cancer Center in Spartanburg, South Carolina, offers some commentary, “The exact reasons for these disparities is unknown, but the fact remains that Black Americans are impacted by multiple myeloma at a higher rate than their White counterparts and more research is needed to better understand this.”

Let’s recap. What do we know? We know multiple myeloma is the most common blood cancer for Black Americans.¹ We know it’s diagnosed at a higher rate at a younger age for Black Americans versus other demographic groups.²

Ok. So, now what? How do we overcome the disparities in outcomes for Black Americans? How do we treat patients with multiple myeloma?

Well, the good news is (yes, there is good news) treatment options for multiple myeloma have greatly advanced in the past decade, especially with improving progression-free survival rates for patients.

At the same time, there is no cure, so patients will most likely relapse at some point.⁷ For some patients, the cancer may respond to initial treatment, but may not respond to treatment following a relapse.⁷

Patients and their families may hear the terms “relapsed” and “refractory” used to describe their disease, and it is important for them to understand what these words mean – and how they differ.

Relapsed multiple myeloma is the term for when the cancer returns after treatment or a period of remission, while refractory multiple myeloma refers to when the cancer does not respond or no longer responds to therapy.⁷

The challenges physicians face when the disease progresses to relapsed multiple myeloma or refractory multiple myeloma is that the disease itself becomes more complicated and is continuously developing resistance to treatments.⁸

For relapsed refractory multiple myeloma specifically, studies have found that CD38, a receptor on multiple myeloma cells and cell surface receptors, is a prime target for anti-body based therapeutics.

By targeting CD38 receptors, monoclonal antibodies, such as Sanofi’s Sarclisa (isatuximab-irfc), are able to bind to the CD38 receptors on multiple myeloma cells to help the body identify and remove the harmful myeloma cells.⁹

Sarclisa is an FDA-approved treatment option, in combination with two other treatments named pomalidomide and dexamethasone – commonly known as pom-dex – in the clinical setting.⁹

As Dr. Buck states, “Specifically, Sarclisa is approved for the treatment of adults with relapsed refractory multiple myeloma.”⁹

Since relapsed refractory multiple myeloma refers to a specific type of multiple myeloma, patients who are eligible for Sarclisa must have received at least two prior therapies, including lenalidomide and a type of treatment called a proteasome inhibitor.⁹

Robert Pugh, who has been living with multiple myeloma since 2014 and regularly interacts with other individuals living with this debilitating disease, has some advice for patients diagnosed with multiple myeloma, “It’s important to be transparent with your doctor and discuss the best approaches for you as a multiple myeloma patient or as a caregiver.

There’s nothing wrong with being cautious and asking questions.” It’s important for patients and their families to work as a team with their doctor to ensure the best possible outcome.

For additional insights from Dr. Buck and Robert on the impact of multiple myeloma on Black Americans, visit our Facebook page to watch our Facebook Live virtual roundtable discussion.

To learn more about Sarclisa as a treatment option for relapsed refractory multiple myeloma, please visit mymyelomaoptions.com.

IMPORTANT SAFETY INFORMATION AND INDICATION FOR U.S. PATIENTS

What is SARCLISA?

SARCLISA is a prescription medicine used in combination with pomalidomide and dexamethasone to treat adults who have received at least 2 prior therapies, including lenalidomide and a proteasome inhibitor, to treat multiple myeloma.

It is not known if SARCLISA is safe and effective in children.

Important Safety Information

Do not receive SARCLISA if you have a history of severe allergic reaction to isatuximab-irfc or any of the ingredients in SARCLISA (see the list of ingredients in full Prescribing Information).

Before receiving SARCLISA, tell your healthcare provider about all of your medical conditions, including if you:

are pregnant or plan to become pregnant. SARCLISA may harm your unborn baby. You should not receive SARCLISA during pregnancy.
- Females who are able to become pregnant should use an effective method of birth control during treatment and for 5 months after their last dose of SARCLISA. Talk to your healthcare provider about birth control methods that you can use during this time.

Tell your healthcare provider right away if you think you are pregnant or become pregnant during treatment with SARCLISA.

are breastfeeding or plan to breastfeed. It is not known if SARCLISA passes into your breast milk. You should not breastfeed during treatment with SARCLISA.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

How will I receive SARCLISA?

SARCLISA will be given to you by your healthcare provider by intravenous (IV) infusion into your vein.
SARCLISA is given in treatment cycles of 28 days (4 weeks), together with the medicines pomalidomide and dexamethasone.
- In cycle 1, SARCLISA is usually given weekly.
- Starting in cycle 2, SARCLISA is usually given every 2 weeks.

Your healthcare provider will decide how long you should receive SARCLISA.

If you miss any appointments, call your healthcare provider as soon as possible to reschedule your appointment.
Your healthcare provider will give you medicines before each dose of SARCLISA to help reduce the risk of infusion reactions (make them less frequent and severe).

What are the possible side effects of SARCLISA?

SARCLISA may cause serious side effects, including:

Infusion reactions. Infusion reactions are common with SARCLISA and can sometimes be severe.
- Your healthcare provider will prescribe medicines before each infusion of SARCLISA to help decrease your risk for infusion reactions or to help make any infusion reaction less severe. You will be monitored for infusion reactions during each dose of SARCLISA.
- Your healthcare provider may slow down or stop your infusion, or completely stop treatment with SARCLISA, if you have an infusion reaction.

Tell your healthcare provider right away if you develop any of the following symptoms of infusion reaction during or within 24 hours after an infusion of SARCLISA:

- feeling short of breath
- cough
- chills
- nausea
Decreased white blood cell counts. Decreased white blood cell counts are common with SARCLISA and certain white blood cells can be severely decreased. You may have an increased risk of getting certain infections, such as upper and lower respiratory infections.

Your healthcare provider will check your blood cell counts during treatment with SARCLISA.

Your healthcare provider may prescribe an antibiotic or antiviral medicine to help prevent infection, or a medicine to help increase your white blood cell counts during treatment with SARCLISA.

Tell your healthcare provider right away if you develop any fever or symptoms of infection during treatment with SARCLISA.

Risk of new cancers.New cancers have happened in people during treatment with SARCLISA. Your healthcare provider will monitor you for new cancers during treatment with SARCLISA.
Change in blood tests.SARCLISA can affect the results of blood tests to match your blood type. Your healthcare provider will do blood tests to match your blood type before you start treatment with SARCLISA. Tell all of your healthcare providers that you are being treated with SARCLISA before receiving blood transfusions.

The most common side effects of SARCLISA include:

lung infection (pneumonia)
decreased red blood cell counts (anemia)
upper respiratory tract infection
decreased platelet counts (thrombocytopenia)
diarrhea

These are not all the possible side effects of SARCLISA. For more information, ask your healthcare provider or pharmacist.

Please see full Prescribing Information, including Patient Information.

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¹International Myeloma Foundation. African American Initiative. Available at: https://www.myeloma.org/african-american-initiative.
²DeSantis, C.E., Miller, K.D., Goding Sauer, A., Jemal, A. and Siegel, R.L. (2019), Cancer statistics for African Americans, 2019. CA A Cancer J Clin, 69: 211-233. doi:10.3322/caac.21555.
³International Myeloma Foundation. What is Multiple Myeloma? Available at: https://www.myeloma.org/what-is-multiple-myeloma. Accessed January 2019.
⁴National Cancer Institute. Myeloma Cancer Stat Facts. Available at: www.seer.cancer.gov/statfacts/html/mulmy.html.
⁵American Cancer Society. Signs and Symptoms of Multiple Myeloma. Available at: https://www.cancer.org/cancer/multiple-myeloma/detection-diagnosis-staging/signs-symptoms.html.
⁶Multiple Myeloma in African Americans. (n.d.). Multiple Myeloma Research Foundation. Available at https://themmrf.org/2019/08/26/multiple-myeloma-in-african-americans/. Accessed September 2020.
⁷Multiple Myeloma Research Foundation. Multiple Myeloma Prognosis - Multiple Myeloma Survival Rate. Available at: https://themmrf.org/multiple-myeloma/prognosis.
⁸Larsen J, Kumar S. Evolving Paradigms in the Management of Multiple Myeloma: Novel Agents and Targeted Therapies. Rare Cancers Ther. 2015; 3: 47–68. doi:10.1007/s40487-015-0009-4.
⁹SARCLISA® (isatuximab-irfc) Full U.S. Prescribing Information. sanofi-aventis U.S. LLC. Bridgewater, NJ.