The striking successes of the last 15 years or so in treating patients with myeloma, a cancer of the bone marrow, resulting in longer life spans and better quality of life is what keeps Vincent Rajkumar buoyant. For this haematologist and oncologist at Mayo Clinic, in Minnesota, it has been hard work battling myeloma, but also, in many aspects rewarding.
Among the top global experts, including several Indians, in the field of treating myeloma, Dr. Rajkumar was in India recently to attend the Indian Myeloma Congress and pledge support for the Indian Myeloma Academic Group. He also stopped by in his hometown Chennai, and spoke to The Hindu about the many developments in cancer care, the frenetic pace of research in the field, the genetic nub of myeloma and hinting, from his vantage position, at what the future might hold.
In Dr. Rajkumar’s view, a population-based study that would examine Indians’ predisposition to myeloma is necessary. He has been at the forefront of multi centric collaborative trials in the U.S., and suggests that this should be quite easy to do in India.
"I’ve been encouraging doctors here to form a network of key colleges and centres that can work together. Then, pick a good trial that can be easily done in India- and perhaps something no one else is doing. I’m sure we can make some important discoveries far quicker because of the volume of patients we have in India.”
Among his pre-occupations is a deep-seated interest in studying racial disparities in predisposition to myeloma. “It is two or three times more common in African Americans than whites. That is a lot more than most cancers,” he says. “And to me, if you can understand why African Americans get myeloma more commonly than white people, you can actually understand why people get myeloma in the first place. You are studying the mechanism for the disparity and hoping that it gives you a clue into carcinogenesis in general.”
He goes on to explain: “My gut feeling is that Indians too have a higher risk of myeloma than whites. And I don’t have a specific reason, but I would like somebody here to really find out if that is truly the case - do a population-based study to look at the prevalence of the precursor condition to myeloma and see if we have two or three times more. All we need are 3000-5000 Indians who are sampled from a defined geographic area.”
And to some extent, if response to therapy varies by the racial group, then studying racial origins will also hold the key to better treatment protocols. “We should work towards access for drugs so that patients have equal access to medications and treatments,” Dr. Rajkumar says, touching on a pet peeve that has him regularly storming bastions in the U.S. – drug pricing.
In addition to being part of some original work identifying biomarkers that help identify and treat patients before symptoms occur, he leads clinical trials to test medications. Besides validating formulations for use in the United States, the research also delves into several candidates poised to become the future of treating cancer.
“One is monoclonal antibodies that target antigens that are on the cancer cell. So as long as you choose the antigens carefully, you should be able to target only the cancer cell and leave the others. Weaponising that antibody with some other chemical that can kill the cell even more powerfully, is also possible,” he says. The other idea is immunotherapy – modern techniques are specific - when the patient’s own T cells are engineered to fight a particular cancer.
The third fascinating area, pregnant with possibilities, is virotherapy, Dr. Rajkumar explains. Here, viruses are harnessed as therapies with the aid of biotechnology. One of the ongoing trials in this area is with a virus called the vesicular stomatitis virus (VSV) which does not affect humans, but the hope is that it will go in and fight the cancer cells. The challenge here, will be targeting the cancer cells, he says.
