Scientists develop gene test to tell if blood cancer drugs will work

Scientists have developed a test to determine which blood cancer patients will benefit most from a drug that can prevent their cancer from returning. The test, which looks for genetic clues in cancer cells, can identify the 10 percent of patients who see little effect from the life-saving lenalidomide.

This could spare them unnecessary side effects like exhaustion, infections and a higher risk of other cancers, though experts need more data before they know if it’s safe to stop taking the drug.

But it also helps identify patients who may need other medicines in addition to lenalidomide, and gives peace of mind to those who are likely to benefit.

The test is so useful that experts are urging it be used each year as a guideline for the treatment of the 6,000 Britons diagnosed with myeloma, a form of blood cancer.

Many myeloma patients take lenalidomide for up to ten years to try to control their disease.

‘The drug is well tolerated by most, but some suffer from side effects such as fatigue or susceptibility to infection,’ says Dr Martin Kaiser, haematologist consultant and clinical scientist at London’s Institute of Cancer Research.

“Some take as long as ten years. A common question they ask is, “Do I really need to keep taking this drug?” and ‘How much does it actually help me?’ ‘

Some studies have shown that long-term use of the drug may be associated with an increased risk of certain cancers, including Hodgkin’s lymphoma. Myeloma affects a type of blood cell called plasma cells, which help fight infection and are made in the bone marrow — the spongy tissue in the center of the bones.

It causes plasma cells to multiply excessively, causing a buildup of defective cells in the bone marrow, which can damage the bones.

This also interferes with the production of other blood cells, preventing the body from effectively fighting infections. The disease is sometimes called multiple myeloma because the bone marrow is affected in several areas, such as the spine and ribs.

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

Lenalidomide blocks the development of abnormal cells, keeping the cancer at bay for an average of about three years, compared to two years without treatment. ‘But there is huge variation – for some it’s a decade, for others it’s a year,’ says Prof. Kaiser.

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

In the study, researchers from the Institute of Cancer Research and the University of Leeds performed the new test on 556 recently diagnosed myeloma patients. This involves taking a piece of bone marrow tissue through a needle in the back, under local anaesthesia, and looking for patterns in the cancer DNA.

The scientists found that one-third of patients with a given pattern lived on lenalidomide for an average of just under five years, compared to an average of about three. Meanwhile, about one in 10 with a different genetic pattern didn’t benefit as much – with similar results to those not taking lenalidomide.

‘We are testing new combinations of drugs for this group that prove to be beneficial,’ says Dr Kaiser. “Those who might benefit less may want to consider options such as clinical trials to test new drug combinations.”

The test, which looks for genetic clues in cancer cells, can identify the 10 percent of patients who see little effect from the life-saving lenalidomide. This can spare them unnecessary side effects such as exhaustion, infections and a higher risk of other cancers (stock photo)

Experts say it would be feasible 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 Prof. Kaiser. ‘It helps us to advise patients better about their treatment.’

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

Her doctor recommended the test, and the results showed her cancer was not genetically high risk.

“My cancer protein levels have dropped since taking lenalidomide and are no longer measurable,” she says. “The test has given me peace of mind to know that the drug is helping to keep the cancer away for as long as possible.”