Oncology Compass logo
Issue 6
JULY, 2023


The digest for the oncologist


The doctors are performing the surgery
«Everything Hurts»:
a Journey with Multiple Myeloma

The challenge that molded Andreas Wickiinto the strongest version of himself

Is This the Drug That May
Transform Treatment?

GENESIS phase III trial: investigational drug increases number of stem cells

New Moves Against a Powerful Opponent

Visiting PD Dr. med. Sabine Gerull at KSA Group




Getting Access to the Most Modern drug Classes

The treatment landscape is rapidly evolving – stay tuned for new studies in Multiple Myeloma

Once upon a time there were two drug classes approved for the treatment of multiple myeloma (MM) – the alkylating agent Melphalan and Prednisone. Within the last 20 years, 30 new agents for this indication have been approved by the FDA and EMA, with a significant improvement in outcomes for MM patients.

Furthermore, new diagnostic tools have implied new staging systems. After the introduction of the SLIM CRAB criteria as new MM defining events and due to the increase of therapeutic options, the patients are treated earlier. The biological risk stratification of the disease is a continuous matter of debate, and although there have only a few clinical trials been conducted with an upfront risk stratification of the patients, published recommendations suggest different treatment strategies for standard and high risk patients. These are mainly based on the different outcomes in subgroup analyses of the clinical trials.

As in most other areas in hemato-oncology, the treatment landscape is rapidly evolving, based on combination therapies of different new drug classes, which resulted in a median PFS of the current standard first line therapies of 5.5 years and 5 years, respectively, for transplant eligible and non-eligible patients. In Switzerland, we have access to the most modern drug classes (CAR T-cells and T-cell engagers), with the main focus now being on the drug availability, safety issues and the best sequencing of these modern immune therapies.
«As a new member of the scientific board of Oncology Compass, I’d like to support my fellow haematology and oncology practitioners, identifying and commencing practice changing data from the high volume publications in the field.»
Dr. med. Erika Lerch, MD
Dr. med. Erika Lerch, MD
Department of Medical Oncology and Transplant Unit, Oncology Institute of Southern Switzerland (IOSI), EOC
Myeloma cells

All about multiple myeloma

This issue mono-thematically deals with Multiple Myeloma (MM), the cancer type recently added to the Oncology Compass platform.

In its initial stages, it may not manifest any symptoms, often being detected through a regular blood test. The main symptoms include bone pain in the back, hips and ribs and tiredness. MM is diagnosed based on blood or urine tests finding abnormal proteins, bone marrow biopsies finding myeloma cells, and medical imaging to give detailed information about the cancer. Treatments of MM include targeted cancer drugs, chemotherapy, and steroids. The outcomes of treatment depend on a variety of factors, such as the stage when it is diagnosed, age and fitness level, as well as the type of treatment received.
It is difficult to judge survival statistics because treatments are advancing rapidly. Based on data concerning people diagnosed between 2013 and 2017, about50% lived five years or more post-diagnosis, with about 30%living ten years or more.

Source: Cancer Research UK


Interview with patient andreas wicki


A Patient’s Journey with Multiple Myeloma

By Susan Johnson
Andreas Wicki’s journey is a tale of remarkable resilience. In his interview with Digest, his unwavering spirit shines through as the former FCZ sales manager narrates his battle with multiple myeloma. It becomes apparent that he is a fighter, refusing to be defeated. «In my life, nothing was handed to me on a silver platter. But the good thing that came out of it is that these challenges fueled my strength and opened my heart.»
Andreas Wicki

Andreas Wicki informed his friends and followers on Twitter: «Since November 2018, my every- day life has been marked by many visits to doctors/hospitals. I have an incurable blood cancer. Multiple Myeloma!»

Photo courtesy of Andreas Wicki

Hailing from Wollerau, at the Lake of Zurich, Andy (49) was an optimistic individual with a zest for life. He always used to be on the move, playing soccer and tennis, engaging in weight training, and embracing every moment with enthusiasm. His wanderlust took him to various corners of the globe, and Despite his background in electrical installation, his passion for sports steered him towards a career as a sales manager for the football club FC Zürich.

However, the fall of 2018 marked a turning point in Andy’s life, an abrupt shift that would test his resilience to its core. At the age of 45, Andy found himself increasingly plagued by back pain. As November unfolded, the pain intensified, and Andy had a major breakdown while accompanying his then-girlfriend to the airport.

Back Pain is an Indication

On the drive home, the pain in his back became excruciating. It was so intense that Andy struggled to sit upright in his car. He got home to his friend waiting for his return, and together, they tried everything to get Andy out of the car, but their efforts proved futile.

After two hours of desperate struggle, they had no choice but to call for an ambulance. As the piercing wail of the ambulance siren shattered the silence, they were unaware that it signaled the beginning of a new chapter in Andy’s journey, one that demanded unwavering determination and the resilience of a true fighter.

The Shocking Discovery

The hospital’s cold, sterile walls were witnesses toAndy’s agony as the MRI scan revealed that something was wrong with his twelfth thoracic vertebra. The excruciating back pain persisted, with painkillers proving futile in their attempts to help Andy feel better.

«When the nursing staff rolled me over on the bed, I saw black. The pain was indescribable. I thought I was dying.»

Yet unbeknownst to Andy, the degenerated plasma cells in the bone marrow had softened his thoracic vertebra so much that it broke. When the doctors delivered this unfortunate news, a storm of emotions raged within Andy. He looked out of the window, a tear rolling down his face. His first question was, «What can I do?».

Soon Andy underwent surgery aimed at mending his fractured vertebra, and immediately afterward, the entire rehab began. The pain that followed was insurmountable, leaving him fraught and anguished.
«It hurt so much to learn to stand up and walk again. I cursed the physiotherapist during that time.»
Yet, amidst the turmoil, Andy found comfort in the unwavering support of his loyal friends. They stood by his side through the darkest times, ensuring he never felt alone. Even during the joyous season of Christmas, they refused to leave his side and celebrated together, giving him hope and lifting his spirits.

After seven long weeks, Andy was allowed to return home. However, his battle was far from over. Another surgery was scheduled due to a wound healing disorder, followed by two high-dose chemotherapies coupled with the extraction and processing of stem cells from his body.

Chemotherapy Complications

The first therapy worked well for Andy. He was mentally strong, and his body responded positively. But, the second high-dose chemotherapy was less smooth–different departments, different staff, and more complications.

Despite the setbacks, Andy’s spirit remained unyielding, even when the medical professionals told him he had a mere four years to live. He thought, «Now more than ever!»
«You feel miserable during high-dose chemotherapy. The body changes, and everything hurts.»
His determination grew stronger, and he embraced life with renewed vigor. As the year drew to a close, on December 11, 2019, Andy’s unwavering faith paid off, and his goal of not spending another Christmas in the hospital came to fruition. Andy was finally allowed to go home.

Learning to Live a New Life

Andy’s life has transformed significantly from what it used to be in the past. He now receives therapy every two weeks and can no longer work in his usual job.
On the positive side, his body has adapted to regular therapy, and although he experiences numbness in his fingers and toes, there are no other side effects.

However, coping with these circumstances is undeniably challenging. «Getting through the long days and staying positive is not always easy, especially when you used to be so active in the past. What’s interesting is that you can’t see what I am going through on the outside. That can be both a good and a bad thing because it means nobody sees the struggles I face internally.» However, amidst the struggles, Andy remains grateful because he knows his situation could have been much worse. «I could have ended up in a wheel- chair or even died.»

Relying on Mental Health Trainer

Initially, Andy relied on a mental health trainer to support his emotional well-being. ”She took away my fear of things I couldn’t control. During the high-dose chemotherapy, she helped me calm down by shifting my focus from the negative to the positive. Thanks to her, I have learned not to question everything, not to have too high expectations of myself, and not to worry about the future.”

Now, Andy finds solace in the unwavering support of his girlfriend, who lost her former partner to cancer. “She went through something similar and understands me. Mutual understanding is the most important thing to make ends meet together. Because when someone has cancer, the whole family has cancer.”

Empathetically sharing his advice with others facing similar challenges, Andy emphasizes that every person’s story is unique, but how we deal with it matters. He says that mental training can make a significant difference in coping with difficult situations.

Despite his journey, Andy maintains a positive outlook. As far as multiple myeloma is concerned, he understands that advancements in medicine are constantly being made, which gives him hope for the future.
Man and woman under sun shadow in the garden

«Whether there will be enough time for me is written in the stars. But I have great friends and a wonderful partner I will marry soon. I am very grateful for all these positive vibes.»

Photo courtesy of Andreas Wicki


Filter 33 highly relevant studies on Multiple MyeloMa

Paper pages


Dr. David J. Chung

The majority of patients are not cured with their initial treatment. Dr. David J. Chung believes that by exploring different combinations of newer therapies, a higher fraction of cures might be achieved.

Photo: Dr. David J. Chung

High-dose chemotherapy (HDT) with autologous stem cell rescue, aka Autologous Stem-Cell Transplantation (ASCT), has been the standard of care for Multiple Myeloma (MM) patients since the 1990s. However, the therapeutic arsenal is rapidly evolving. Digest asked Dr. David J. Chung, a renowned expert in this field: Will it continue to remain an integral part of treating MM?
In such a scenario, is it possible that ASCT will go obsolete in the near future? We discussed this with David J. Chung, Director of Adult Bone Marrow Transplant and Cancer Immunotherapy Fellowships at Memorial Sloan Kettering Cancer Center (MSKCC), New York City, to learn more about his perspective on ASCT’s role in the battle against MM.

Dr. David J. Chung, the latest additions of treatments, like immunomodulatory agents and proteasome inhibitors, are pushing the boundaries of treatment options and offering new hope to patients. What are your thoughts on these new agents in development?

I think the critical aspect when approaching myeloma therapy is that we’re fortunate that there are a lot of new treatments available. Myeloma, over the last decade, has witnessed significant advances with the introduction of new classes of drugs, whereas prior to that, the treatment options were fairly limited. With the newer agents, the goal is to try and optimize their usage and figure out the best combinations, sequencing, and timing of different therapies.

The overriding principle when approaching someone with myeloma is that you want to optimize the treatment to get the best response possible during each phase of treatment. I say each phase of treatment because, unfortunately, myeloma is technically not curable with all the available treatments. There’s probably a small fraction of people who, after finishing their initial treatment, are cured, but it’s such a small fraction that we generally don’t talk about a cure for myeloma. So, with these new treatments, we’re striving to get closer to a cure.

«There is a growing preference for a four-drug combination.»

Getting back to what I was saying, when a patient goes through any phase of treatment, we’re trying to optimize the treatment to get the best response possible in order to get the best duration of control. This is essential because myeloma is not a single disease. It’s very heterogeneous, and a one size fits all approach doesn’t work, especially concerning patients with standard risk versus high-risk disease.

That being said, do you think ASCT still has a place in MM treatment, given the introduction of novel agents like monoclonal antibodies?

Previously, the standard of care for newly diagnosed patients was the triplet regimen therapy–three drugs, usually an IMiD, a proteasome inhibitor, and dexamethasone. But now, with the advent of CD38 monoclonal antibodies, specifically daratumumab, a relatively new- er drug, there is a growing preference for a four-drug combination as the initial therapy. The reason for that, again, is to maximize response while keeping in mind that you have to balance disease response with toxicities or side effects from the therapies.

Now, when it comes to ASCT, the general approach to any newly diagnosed myeloma patient, in most cases, is still to do stem cell collection for the purpose of a possible transplant. But the field is evolving, and people have re-addressed the issue of transplants and where it fits in terms of timing. In general, the clinical trial data still support the role of transplant in the up-front setting, at least as of now.

Our approach at MSKCC is to offer transplants to patients when they’re newly diagnosed if they are transplant eligible. Even if the patients are hesitant to proceed with a transplant, we still recommend stem cell collection so they can at least have that as an option in the future.

Is there a reason why you recommend transplants to patients?

The reason why we generally recommend transplant is, again, to optimize therapy for the best, deepest, and longest possible response. And clinical trials still support that as a general strategy. There are two large studies that you may already be aware of.

First, the IFM 2009 study comparing RVD alone versus RVD with a transplant showed a significant progression-free survival (PFS) benefit of about a year in patients who received a transplant. Second, the Determination Study that was more recently published found that the PFS of patients who had a transplant was more than 20 months, better than the patients who did not receive a transplant. There are more details to that, but in general, that’s the rationale for why we still recommend it. As we progress, I think several issues will ultimately influence how transplant continues to be a part of myeloma therapy.

«As of today, transplant remains the standard care.»

Can you give an example of one such issue?

For instance, the role of assessing response to therapy. Currently, the best tool at our disposal is the Minimal Residual Disease (MRD) testing that we do at various stages of treatment to assess the depth of response. There’s a clear signal that the deeper the response, meaning those who achieve MRD negativity, do better in terms of PFS and overall survival (OS). Nonetheless, how we can use that to guide treatment decisions is evolving.

At present, no studies have been published that show you can use MRD testing at a single time point to make a decision. Sustained MRD negativity is critical. And again, that speaks more to the issue of really trying to get the deepest response possible, as that may trans- late to a longer period of MRD negativity, which, again, is more important than a one-time measure.

«We don’t want an absolute age cutoff for transplants.»

Where oncology is moving now, specifically in myeloma, newer immune-based treatments have been approved in the relapse setting. But as with all new treatments for myeloma, they are now being explored in earlier lines
of therapy and ultimately will be explored as first-line or front-line therapy.

I’m specifically talking about Chimeric Antigen Receptor (CAR) T-cell therapies and bispecific antibody treatments. Both treatments leverage the immune system to exert an anti-tumor effect, and it’s quite possible that several years from now, if we were to have the same conversation, we will be talking about those as the front-line treatments and then transplant at some point might be moved to later-line therapy. But as of today, transplant remains the standard of care for MM, at least at MSKCC.

What are the decision-making factors for ASCT? Or, how do you determine if a patient with multiple myeloma is a good candidate for a stem cell transplant?

In general, myeloma patients tend to be older. The average age of diagnosis is a little around 69 years old or so–that’s an older population.

People tend to acquire various medical conditions
as they age, and there are several points to consider when deciding whether or not someone is eligible for a transplant. The first point is evaluating if a candidate is extremely elderly or very frail. Typically those are the patients who do not proceed to transplant.

However, we don’t have an absolute age cutoff for transplants. In the past, some centers had age cutoffs of 65 or 70, where anyone over those ages was not deemed eligible for a transplant. But now we realize physiological age is more important than chronological age. Meaning there are some people who are, for instance, 70 years old, but they have excellent functional status–they don’t have many medical conditions and are more akin to someone who’s 50.

On the other hand, some people are maybe 50, but have a lot of medical conditions, are physiologically older, and might be more prone to having side effects if they go through with a transplant. So it’s the overall health that we evaluate, which includes an individual’s performance status, as well as medical conditions.

Talking about medical conditions, there aren’t too many medical conditions that immediately exclude someone from eligibility, but that’s something we reassess over time. At a baseline, before someone has a transplant, we check their cardiac function and pulmonary status, as well as their renal and hepatic function.

I would say that, in my experience, there are very few people who can’t get through a transplant, even if they have pre-existing medical conditions requiring input from a cardiologist or a pulmonologist. What we tell people is that if you have more medical conditions at a baseline, you’re at a higher risk of having more toxicity from the transplant, which could translate into having a longer recovery from the treatment.

Illustration of the patient's treatment process

The complete blood count (CBC) is a test that measures the levels of red cells, white cells, and platelets in the blood. If there are too many myeloma cells in the bone marrow, some of these blood cell levels can be low.

Photo: © 2021 Terese Winslow LLC

What is the best sequence of treatment for newly diagnosed patients?

The current phases of treatment are induction treatment, which is the initial treatment that someone gets when they’re first diagnosed. At MSKCC, the standard is to do four drug-based or quadruplet regimens, which can include an anti-CD38 monoclonal antibody, an IMiD, a proteasome inhibitor, and dexamethasone.

We generally give four to six cycles of treatment, at which point we collect stem cells. Then if a patient is transplant eligible, we currently recommend a trans- plant, which is then followed by maintenance treatment, typically Revlimid. We continue Revlimid maintenance for as long as someone responds well and their myeloma remains under control.

«We are using the MRD test to evaluate the stem cells we collect for transplant.»

Now, if we speak in five years, it might be that for certain patients, we might say the best upfront treatment might be a CAR T-cell or something else. But currently, our standard is what I just described in terms of induction treatment, consolidation with the transplant, and then maintenance therapy.

Are there any trial results you anticipate coming out this year that might inform ASCT for MM? Or, are there any new developments or advancements in ASCT that you think will improve outcomes for patients with multiple myeloma?

I can’t think of any study off the top of my head that will result within the next year. But we’ve done a study here where we have examined the role of the MRD status
of patients’ stem cells. The MRD test is done on bone marrow samples to see how deep their responses are to each phase of treatment.

We’ve adopted that and are using this test to evaluate the stem cells we collect for transplant. We reported these results at the ASH 2022 annual meeting. It was an oral presentation where we showed that patients who undergo an ASCT with an MRD-negative stem cell graft have superior PFS and OS compared to patients with an MRD-positive stem cell product.

Ultimately, we believe that might be one way to stratify people and make treatment decisions after transplant, where if you see that a patient got a transplant with an MRD-positive graft, that person is at risk of relapsing earlier. So you might want to modify what you do after the transplant beyond standard maintenance therapy.

Another thing we know from our internal data is that patients who receive quadruplet induction therapy (the CD38 antibody with an IMiD, a proteasome inhibitor, and dexamethasone) tend to have very high rates of MRD-negative stem cells.

Is there a particular area of unmet need that should constitute the key focus for ASCT research efforts in 2023?

I think it’s more of what we’ve already covered, specifically which patients need a transplant upfront versus later. And is transplant going to continue to be the standard of care after initial therapy, or will it be supplanted by another treatment like a CAR T-cell, a bispecific, or combinations?

Currently, the vast majority of people with myeloma are not cured with their initial treatment. But several years from now, as we explore different combinations of newer therapies, might we achieve a higher fraction of cures? That’s something that’s evolving and will have to play out over time.

How does the future of MM, and particularly ASCT, look like?

Research efforts focusing on the biology and immuno-biology of myeloma will be important in honing treatments and the sequencing of treatments, both with and without a transplant. As we gain more insights into myeloma disease biology, it will allow us to optimize therapeutic approaches and ultimately improve clinical outcomes.

Memorial Sloan Kettering Cancer Center at 1275 York Avenue in New York.

Memorial Sloan Kettering Cancer Center at 1275 York Avenue in New York.

Photo: MSKCC


Memorial Sloan Kettering Cancer Center

The Memorial Sloan Kettering Cancer Center’s (MSKCC) mission is to end cancer for life. The personalized and expert care offered to patients of all ages at the center is driven by research from the Sloan Kettering Institute. Scientists across MSK collaborate to conduct innovative research that informs their understanding of cancer and enhances their ability to prevent, diagnose, and treat it.

Alongside being one of the world’s renowned cancer centers, MSKCC has been recognized as one of the top two cancer hospitals in the country by U.S. News & World Report for over 30 years.



by Roland Schäfli

Every time Sabine Gerull is confronted with one of the 30 to 40 new diagnoses of multiple myeloma at the Cantonal Hospital Aarau (KSA) each year, she faces the question of which therapy can keep this incurable disease at bay. Digest met with the Deputy Chief Physician of the KSA for an interview.

PD Dr. med. Sabine Gerull, Deputy Chief Physician at KSA, Head of Haematology and Transfusion Medicine.
PD Dr. med. Sabine Gerull, Deputy Chief Physician at KSA, Head of Haematology and Transfusion Medicine.

Photo: KSA
Sometimes, Sabine Gerull has known her patients for several years. Sometimes even decades. This is because the cancer originating from the bone marrow’s plasma cells persists until the end of life. The prognosis for people suffering from multiple myeloma has steadily improved.

«Our greatest hope remains to cure the disease someday. This may be possible if it can be diagnosed and combated at an even earlier stage. Today, all we can do is keep multiple myeloma at bay.»

The fact that the number of new cases has risen in the last ten years can be attributed to people reach- ing increasingly older ages and improved diagnostics of this rare type of cancer. Although early detection is not yet established, «we are now searching more broadly for myeloma, such as when investigating polyneuropathy or renal insufficiency, which allows malignant changes in the plasma cells to be discovered earlier,» explains the Deputy Chief Physician.

Non-specific Symptoms

The cancer hides its symptoms – sometimes they are non-specific, sometimes they do not appear at all. Complaints often persist for months before the diagnosis is made. «We become alert when back pain, whose cause cannot be found, has been treated for a long time.» Some ailments point to the disease, such as osteoporotic fractures (bone fractures attributable to bone loss) or anaemia (a lack of haemoglobin, the red blood pigment).

Once the suspicion has been confirmed, Sabine Gerull is the bearer of bad news. The haematologist has found that there is no point in sugar-coating the findings. «It is important to present the treatment plan immediately.»

«The course of the disease varies greatly, which makes prognosis difficult.»

The most frequently asked question of those affected is, of course, how long they have left to live, and how the cancer will affect this time. «The course of the disease varies greatly, which makes prognosis difficult.» In particular, the cytogenetic findings (the changes in the chromosomes in the malignant cells) provide information. «Our approach is very approximate. The goal is to reach a state where the disease no longer plays an overpowering role in everyday life.»

Age is Crucial

In first-line therapy, the first treatment after diagnosis, the KSA always treats with medication, possibly supplemented by symptomatic radiotherapy. At the KSA, it is first clarified whether high-dose therapy with stem cell transplantation is an option. It has led to an increase in the rate of complete remissions in the era of new drugs in first-line therapy. Criteria such as the functioning of the heart, lungs, and kidneys must be taken into account.

The most important, however, is the biological age. While most cases of the disease occur in both sexes in the age group of 70 to 79, the cancer can also strike much younger people. An upper age limit for high-dose therapy with autologous transplantation is hard to de- fine, but risk factors exclude a large part of the affected from this treatment.

A doctor looking into a microscope
It’s difficult to diagnose multiple myeloma early. Often, it causes no symptoms until it reaches an advanced stage. Sometimes, it might cause vague symptoms that at first seem to be caused by other diseases.

Photo: KSA

Starting Immediately

«While we are able to start treatment on the same day for some patients, such as in cases of renal insufficiency, more time is available in other cases to complete the diagnosis, and with some patients, we monitor the changes without initiating any therapy as of yet.» No delay is tolerated in cases of bone involvement and hypercalcemia (too much calcium in the blood). The probability of living symptom-free after a stem cell transplant is true for a majority of those treated.

«Studies show that this therapy extends progression-free survival.» However, how long a patient can live without symptoms can vary significantly. While the disease is kept at bay for up to ten years for some, it returns for others within a year.

The relative 10-year survival rate is reported to be 31% for men and 30% for women. «New, more effective therapies have the potential to extend this period even further,» Sabine Gerull expresses her hope in ongoing research.

An Empty Donation Registry

While in autologous transplantation the cells come from the patient themselves, in allogeneic transplantation the cells are used from tissue-compatible individuals. However, the effectiveness of a foreign donation with this more intense treatment and increased risk factors is not assured for the treatment of multiple myeloma.

According to the Federal Office of Public Health, more people in Switzerland receive blood stem cells from individuals abroad than vice versa, as the willingness
to donate in Switzerland is rather scarce compared to neighbouring countries. In Sabine Gerull’s opinion, it would be particularly important to win over young men as donors, as their donations are associated with a low- er risk of complications.

Prospects for Success

In the last 15 years, a number of drugs have been approved for first-line therapy. «Where previously only two medications could be combined, we can now use four.» This gives doctors more options, especially in case of relapses.

«The age group for which stem cell transplantation is not recommended is now also treated with the triple combination of well-tolerated drugs,» Gerull reports, «meanwhile, we can promise these older patients a progression-free time of several years – with the differ- ence that they remain in treatment throughout.»

Gerull assumes that these combinations will become even more diverse as soon as more is known about the compatibility and effectiveness of the medications used together.

Doctors during operation process

Interdisciplinary care is elementary in cancer treatment. That is why the KSA specialists from different disciplines discuss the best possible therapy for each patient during the tumor board.

Photo: KSA

Promise of CAR-T Cell Therapy

One of the new therapies Sabine Gerull has high hopes for is CAR-T cell therapy: it allows the genetically manipulated cells of the patient attack the myeloma cells.

Since June 2021, KSA has been one of the few hospitals in Switzerland qualified for CAR-T cell therapy. The therapy is still only used in a few patients for the treatment of multiple myeloma, but the deputy chief physician is convinced that this therapy will become even more prominent in the future.

The cantonal hospital is a public limited company owned by the canton of Aargau and has around 4,600 employees.

The cantonal hospital is a public limited company owned by the canton of Aargau and has around 4,600 employees.

Photo: KSA


KSA Group

At the KSA Group, more than 5,390 specialists from diagnostics, medicine, nursing, therapy and other professional areas are responsible for over 32,200 inpatient and over 787,330 outpatient treatments at five Swiss locations every year.

Oncology, haematology and transfusion medicine form an independent department of the Medical University Clinic. The department consists of the two departments of oncology and haematology of the interdisciplinary oncology centre Mittelland.



By Lavonne Roberts

Digest reached out to six experts representing cutting-edge AI innovation in clinical practice, healthcare systems, and academia to share their perspectives on how AI is transforming healthcare, focusing on oncology.

Dr. Erich Oermann

Dr. Erich Oermann

Neurosurgeon, AI expert, and an Assistant Professor of Neurosurgery, Radiology, and Data Science at NYU

● AI automates tasks that keep doctors from spending time with patients. In cancer research, AI shows promise for drug discovery by analyzing large volumes of biomedical data, such as genomic information, protein structures, and drug databases. It helps identify potential drug candidates. It
can make clinical trials more data efficient, analyze historical clinical trial data to predict outcomes and analyze patient data in real-time to identify potential effects during clinical trials. But it’s crucial to remember that AI is a tool that works with human expertise, ensuring ethical and regulatory standards are met.

Andrew Brosnan

Andrew Brosnan

Tech Strategist and Principal Analyst in Omdia’s AI & Intelligent Automation practice, Primarily Focused on AI Applications in Life Sciences

● AI in drug discovery shows promise by streamlining the design process, reducing the need for physical lab work. It analyzes data “in silico” to suggest molecules for synthesis and testing, minimizing the number of compounds to be evaluated. Additionally, AI’s generative models explore unexplored «chemical space» by proposing unique molecules that differ from those traditionally designed by chemists. At Omdia, we forecast that generative AI in drug discovery is the fastest-growing (health- care-specific) use case for AI software in the healthcare sector through 2027.

Dr. Mona Flores

Dr. Mona Flores

NVIDIA’s Global Head of Medical AI and a Board-Certified Cardiac Surgeon

● One of our most recent projects in the fight against cancer is our collaboration with Medtronic to incorporate AI into endoscopy.

Using NVIDIA’s IGX hardware and Holoscan medical platform, this AI-enabled system facilitates the detection and visualization of cancerous polyps, which can lead to better outcomes when detected early.

Another exciting area in the fight against cancer is our BioNeMo platform. This accelerated suite of generative and predictive biomo- lecular AI models will decrease the time it takes to generate and test drugs, significantly speeding up the journey from bench to patient. An example of this is Insilico, which used generative AI to identify
a preclinical candidate drug for idiopathic pulmonary fibrosis in one-third of the time and one-tenth of the cost. The drug is expected to enter phase 2 clinical trials with patients soon.

Dr. Bodour Salhia

Dr. Bodour Salhia

Interim Chair of the Dept. of Translational Genomics and Genomic and Epigenomic Regulation Research Program co-leader at USC Norris Comprehensive Cancer Center

● There are already numerous examples of AI-assisted clinical applications across the continuum of cancer care, including radiographic imaging and genomics. The FDA has approved breast cancer and prostate cancer imaging detection and diagnosis algorithms. In oncology, complex and variable datasets, not otherwise manage- able, are fed into deep learning algorithms, which are subtypes of AI. The output can become a scoring algorithm that can stratify patients into various groups in a much more precise way.

In my research, we are developing liquid biopsies (blood and genomics-based biomarkers) for ovarian cancer early detection and breast cancer recurrence monitoring.

We use machine learning to build classifiers that can stratify patients into risk groups for cancer or developing recurrence. Machine learning does depend on the data you feed it. So, we must strive to generate data that closes gaps in cancer inequities by including data from diverse populations. Otherwise, the sky’s the limit for AI in oncology and health.

Dr. Ken Stein

Dr. Ken Stein

Senior Vice President and Global Chief Medical Officer at Boston Scientific

● As a doctor myself, I understand the concerns of being replaced by AI, but I don’t foresee that happening. Instead, I see AI as a valuable tool for helping turn data into actionable information that we can apply to patient care. Doctors today are just drowning in data. But data is only useful if it’s simplified and delivered in a way that’s digestible and personal to that physician or patient or disease state. AI can assimilate the latest findings from medical literature that apply to a specific patient. It can help doctors intervene when there’s a chance to prevent harm. It can also provide predictive analytics to guide them in prioritizing their time.

AI is also well underway in revolutionizing the discovery of life-saving drugs. Approximately 270companies are actively engaged in the field of AI-driven drug discovery.

Today, over two dozen drugs using an AI-first approach are in clinical trials, whereas in 2020, there were none.

Dr. Prasenjit Mitra

Dr. Prasenjit Mitra

Affiliate Faculty Member of the Department of Industrial and Manufacturing Engineering at Pennsylvania State University

● Undoubtedly, AI is already changing oncology and the whole of healthcare. Fundamentally, AI can be used to analyze existing data and build prediction models. These prediction models can be used to detect what we see in the existing data or predict the prob- ability of what will happen in the future. In the case of oncology, AI has already been used to analyze imaging that is done to detect the existence of certain types of cancer, its severity, etc. A significant amount of research has succeeded and is ongoing to help build better prediction models for the prognosis of the patient, analyzing genetic data to find causes and cures of cancer, etc.

A lot of work in AI, especially image processing and computer vision, has been done with radiation and analyzing images. The future, of course, is in using next-generation sequencing for precision oncology treatment, in essence, personalizing treatment, leading to much better outcomes and avoiding ineffective treatments.

Photo Credits: SC Media Relations, Boston Scientific, Penn State Media Relations



By Kristina Olujic

According to the GENESIS phase III trial, the investigational drug motixafortide combined with the standard therapy for mobilising stem cells significantly increased the number of stem cells that can be harvested, compared with treatment with the standard agent alone. If approved by regulatory agencies, the combination with motixafortide might improve stem cell transplantation for patients with multiple myeloma.

Frequently Used Treatment

The common therapy for patients with multiple myeloma is stem cell transplantation, in which the patient’s stem cells are harvested and stored while the patient receives intensive chemotherapy. Then, the patient’s stem cells are returned to the patient to assist in recovery. However, for a significant proportion of patients, the number of stem cells that can be harvested is lack- ing for transplant, having a negative impact on patient outcomes.

Senior author John F. DiPersio, MD, Ph.D., the Virginia E. & Sam J. Golman Professor of Medicine, said during the study presentation at the Washington University School of Medicine in St. Louis: «Stem cell transplantation is central to the treatment of multiple myeloma, but some patients don’t see as much benefit because standard therapies can’t harvest enough stem cells for the transplant to be effective».

In the case of a myeloma patient, a minimum of 2 million stem cells per kilogram body weight are required for a stem cell transplant, but greater than 5 million to 6 million stem cells per kilogram body weight is considered optimal.

The GENESIS phase III clinical trial led by physicians at Washington University School of Medicine in St. Louis USA evaluated the superiority of motixafortide plus granulocyte colony-stimulating factor (G-CSF) over placeboplus G-CSF to mobilise hematopoietic stem and progenitor cells (HSPCs) for autologous hematopoietic stem cell transplantation (ASCT) in multiple myeloma.

Encouraging Findings: May They Change Standard Care?

The results showed that when the investigational drug motixafortide was combined with the standard stem cell therapy, G-CSF, optimal numbers of stem cells could have been harvested in more than 92% of patients after two collection procedures, compared to only 26% of patients who received G-CSF plus a placebo.

A significant improvement has also been observed in one collection procedure. The data showed that 88% of patients who received motixafortide plus G-CSF had optimal stem cell numbers, compared to barely 9% of patients who received standard G-CSF plus a placebo.

The combination of motixafortide and G-CSF was safe, well tolerated, and showed a tenfold increase in the collected number of primitive stem cells that are crucial for a patient’s recovery.

John F. DiPersio, MD, PhD is a Virginia E. and Sam J. Golman Professor in Medicine and a Director, Center for Gene and Cellular Immunotherapy.

John F. DiPersio, MD, PhD is a Virginia E. and Sam J. Golman Professor in Medicine and a Director, Center for Gene and Cellular Immunotherapy.

Photo: johndipersiolab.com

«This study suggests motixafortide works extremely well in combination with the standard drug, G-CSF, in mobilising stem cells in patients with multiple myeloma. The study also found that the combination worked rapidly and was generally well-tolerated by patients. We are hopeful that this investigational drug, if approved, will expand the number of patients who can receive an effective stem cell transplant for multiple myeloma.»


By Kristina Olujic

Bispecific antibody REGN5459 demonstrated early and durable responses in heavily pretreated relapsed or refractory multiple myeloma. According to findings from a first-in-human phase I/II trial, the binding affinity of T-cell engagers can be reduced without affecting clinical activity. This innovative therapeutic strategy might minimise the risk of fatal treatment-related toxicity.

High Response

REGN5459, a bispecific B-cell maturation antigen (BCMA) and CD3 antibody, is designed to decrease T-cell binding affinity, resulting in an encouraging efficacy and side effect profile. The study found that when the two highest doses of REGN5459 were administered to patients with relapsed or refractory multiple myeloma, 90.5% of them experienced disease response.

Furthermore, REGN5459 may provide an opportunity to overcome treatment challenges by reducing mitigated cytokine release syndrome (CRS), a common side effect of bispecific antibody immunotherapy that can be fatal.

The phase I/II trial led by Attaya Suvannasankha, MD, an associate professor of clinical medicine in the Division of Haematology and Oncology at Indiana University School of Medicine, assessed the antitumor activity, safety, and tolerability of REGN5459 in patients with relapsed or refractory multiple myeloma.

The newly developed low-affinity bispecific antibody showed a potentially more favourable safety profile in myeloma patients compared to currently available bispecific antibodies.

Outcomes Rivalled Available Therapies

Based on the preliminary data from the phase I/II trial, patients with relapsed/refractory multiple myeloma (n = 43) had an objective response rate (ORR) of 65.1%. Patients treated at higher dose levels ranging from 480 mg to 900 mg (n = 21) had an ORR of 90.5%, of which 61.9% were complete responses or better.

Correlation between T-cell and Tumor cell

Center for Gene and Cellular Immunotherapy, Department of Medicine, Division of Haematology/Oncology, Indiana Unive Virginia E. and Sam J. Golman Professor in Medicine and a Director.

Photo: johndipersiolab.com

In terms of safety, 53.5% of all treated patients experienced CRS, with the majority (46.5%) of these events being grade 1. As a result, the toxicity was determined to be manageable and did not lead to treatment discontinuation in any patients. These findings indicate that binding affinity can be reduced while maintaining clinical activity and minimising CRS.

Attaya Suvannasankha, MD, Associate Professor of Clinical Medicine

Attaya Suvannasankha, MD, Associate Professor of Clinical Medicine, Department of Medicine, Division of Haematology/ Oncology, Indiana University School of Medicine.

Photo: Indiana University

«Dialling down the strength of binding to CD3 might sound contradictory. Why would we not want the therapy to grab the T-cells very hard? Pre- clinical data suggested that decreasing the binding affinity to T-cells might reduce CRS, which may enable us to more safely deliver treatment to patients, particularly those who are older or frailer.»
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