Scientists are developing a gene test to see if blood cancer drugs will work

• Leukemia testing detected 10% of those who could not be helped by life-saving lenalidomide
• Patients can avoid unnecessary side effects such as fatigue and infection

Scientists have developed a test to determine which leukemia patients would benefit most from a drug that can stop 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 drug lenalidomide.

This could spare them unnecessary side effects such as fatigue, infections and an increased risk of other cancers, though experts need more data before they know if it’s safe to stop using the drug.

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

The test is so useful that experts advocate using it to guide treatment for the 6,000 Britons diagnosed with myeloma – a type of blood cancer – every year.

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

“For most people, the drug is well tolerated, but some experience side effects such as feeling tired or susceptibility to infection,” says Dr. Martin Kaiser, a consultant hematologist and clinical scientist at The Institute of Cancer Research, London.

“Some take it for up to a decade. A common question they ask is, “Should I really keep taking this medication?” and “How much is it actually helping me?”

Some studies have shown that taking the drug for a long time may be associated with an increased risk of developing some types of cancer, including Hodgkin’s lymphoma. Myeloma affects a type of blood cell called plasma cell that helps fight infection and forms in bone marrow — the spongy tissue in the center of bones.

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

This also disrupts the production of other blood cells, which stops the body from effectively fighting infections. 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 inhibits the growth of abnormal cells, keeping cancer at bay for an average of three years, compared to two years without treatment. “But there is a huge variance – for some it’s a decade, for others it’s every year,” says Professor 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 than others to stop cancer growth.

In the study, researchers at the Institute of Cancer Research and the University of Leeds administered the new test to 556 patients who had recently been diagnosed with myeloma. It involves taking a sample of bone marrow tissue through a needle in the back, under local anesthetic, and looking for patterns in the cancer’s DNA.

The scientists found that a third of patients with a pattern lived an average of five years shorter on lenalidomide, compared to an average of about three years. Meanwhile, one in 10 people with another genotype didn’t benefit as much – and the results were similar to those who didn’t take lenalidomide.

“We’re experimenting with new combinations of drugs for this group that are showing benefit,” says Dr. Kaiser. Those who might not benefit as much may want to consider options such as clinical trials that test new drug combinations.

Experts say it would be possible to use the test in this way, as it is already widely available on 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 better advise patients when it comes to their treatment.”

Cecilia Brunot, 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 be tested and the results showed that her cancer was not genetically high risk.

“My cancer protein levels have decreased since I’ve been on lenalidomide and are no longer measurable,” she says. “The test gave me the peace of mind of knowing that the drug was helping to keep the cancer away for as long as possible.”