Persistent Multiple Myeloma Relapses... 'Best Drug First' is the Answer [Healthy Hankyoreh]

Multiple myeloma, a persistent and relapsing blood cancer, is surging in South Korea, driven by the nation's aging demographic. The number of new cases has doubled every decade, surpassing 2,000 in 2023, with the total patient population exceeding 10,000. Globally, cases are projected to rise by 70% in the next two decades.

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Recently, there are so many effective drugs for multiple myeloma worldwide that even specialized professors in university hospitals can fall behind if they neglect related studies for just 3-6 months.

Despite the growing patient numbers, South Korea's treatment environment lags behind rapid medical advancements. While innovative therapies like bispecific antibodies and CAR-T cell treatments are transforming care, the domestic medical system, structured around individual drugs, fails to integrate these changes effectively. This disconnect hinders timely access to optimal treatment for patients.

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Multiple myeloma is one of the cancers where the fundamental oncological principle of 'using the most effective drug first' is most crucial.

Experts stress that the core of multiple myeloma treatment lies in achieving the most effective initial therapy to maximize remission duration and improve long-term outcomes. "Leaving residual cancer cells from suboptimal early treatment can lead to a rapid disease progression where no drug is effective later," warned Lee Jun-ho, a professor of hematology-oncology at Samsung Medical Center. He advocates for using the most potent and effective drugs from the outset to completely eradicate remaining cancer cells.

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We need to review institutionalizing academic proposals, such as separating blood cancers from the cancer disease review committee system or establishing a national systematic roadmap for blood cancer standard treatment, to ensure patients receive optimal treatment in a timely manner, keeping pace with the rapidly changing field of hematologic cancer treatment.

The disparity in new drug accessibility between South Korea and Japan is stark, with a significant difference in survival rates. Lee urges for systemic reforms, including separating blood cancers within the cancer disease review committee and establishing a national standardized treatment roadmap for blood cancers. This would ensure patients receive timely and optimal care aligned with the fast-paced evolution of hematologic cancer treatment.

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If the first-line treatment is not effective or the relapse interval shortens, cancer cells mutated to gain resistance to chemotherapy become dominant, and the disease progresses rapidly, like a dam breaking.