What are the treatments for Waldenstrom macroglobulinemia and what's in the pipeline? Can Waldenstrom patients plan for a higher quality of life? Dr. Jorge Castillo, Clinical Director, Bing Center for Waldenstrom Macroglobulinemia, Dana Farber Cancer Institute, presents an overview of his presentation at the 2020 IWMF with Patient Power co-founder Andrew Schorr.

Andrew Schorr:
Hello and welcome to Patient Power. I'm Andrew Schorr and we're joined by Dr. Jorge Castillo who's at the Dana-Farber Cancer Institute in Boston and is the Clinical Director of the Waldenstrom's Center there. Dr. Castillo, welcome.

Dr. Castillo:
Hi. Yes. Hi, Andrew. Thank you for having me here.

Andrew Schorr:
So, I wanted to talk to you on behalf of the IWMF about current and future treatment for Waldenstrom.

Types of Treatments for Waldenstrom macroglobulinemia

Dr. Castillo:
Yes, so I mean, I think the good news is that we have several treatment options for patients with Waldenstrom's and actually most of those options are very, very effective for the patient.

So, I think we can separate the treatments in different groups. I think one of the first groups that we developed, in terms of treatments for patients with Waldenstrom's, is chemotherapy. So chemotherapy, which we typically combine with antibodies, like rituximab (Rituxan), have been used for many years and in many countries outside of the United States. Still is the mainstay treatment for patients with Waldenstrom's macroglobulinemia.

Now in the United States, and especially at the Dana-Farber, we have been trying to move into non-chemotherapeutic agents. So Dr. Treon has developed a number of different treatment options that are out there in the market. We have a group of medications called proteasome inhibitors. I knew about three of them in the market already; bortezomib (Velcade) and carfilzomib (Kyprolis) and ixazomib (Ninlaro). And now we have the BTK-inhibitors as well, of which ibrutinib (Imbruvica), approved now, but for the treatment of patients with Waldenstrom's. And then we have now, getting into the future treatment options, now we have a new generation BTK inhibitors, like acalabrutinib (Calquence) and zanubrutinib (Brukinsa).

We also have an interesting molecule. It's a BCL-2 inhibitor. BCL-2 is a protein that actually allows cells, malignant cells to immortalize, and basically, they don't die when they are supposed to. So this medication called venetoclax (Venclexta), which is approved for other conditions like chronic lymphocytic leukemia and acute myeloid leukemia, it's already been evaluated in clinical trials in patients with Waldenstrom's, too. And as we move forward within the field, I think combining BTK inhibitors like ibrutinib and acalabrutinib and zanubrutinib with other agents is basically what is coming down the road.

Clinical trials combining chemotherapy with BTK inhibitors, combining proteasome inhibitors with BTK inhibitors and combining BTK inhibitors with BCL-2 inhibitors and other antibodies as well.

Andrew Schorr:
So Dr. Castillo, when you look at it all together, it sounds like for some patients there's still a place for some chemo but for many others not. And it sounds like you have more to work with than you ever have had before. So, you get to see it all. For most patients now, are you optimistic that they can have a good life?

Dr. Castillo:
Oh, we see it already. I mean, we have been in multiple meetings with patients in which we say, whoever has been alive with Waldenstrom's for the last 15 years, stand up. And we have a lot of people stand up. 20 years? And a lot of people stand up. So we are seeing this already. I think we are going to be seeing more of that even. Even longer survivals, even better quality of life moving forward. And I think that is a very encouraging aspect of things when we think about it.

Andrew Schorr:
Well, thank you for your devotion to Waldenstrom's patients, Doctor. Jorge Castillo from Dana-Farber Cancer Institute. Thanks for all you do and for being with us on Patient Power.

Dr. Castillo:
Certainly, my pleasure. Thank you very much, Andrew.

Andrew Schorr:
I'm Andrew Schorr. Remember knowledge can be the best medicine of all.

You may watch the interview by clicking the following link:
https://patientpower.info/waldenstrom-macroglobulinemia/treatments/current-and-future-treatments-for-waldenstrom-macroglobulinemia