How an adaptive platform trial is accelerating myeloma research and bringing cutting-edge treatments directly to patients in their communities
Dr. Craig Cole ran headfirst into one of oncology’s toughest challenges two decades ago when multiple myeloma was still largely a death sentence. Now a Hematologist-Oncologist at Karmanos Cancer Institute in Michigan, he serves as an advisor to the MMRF Horizon Trial, a groundbreaking adaptive platform trial that’s revolutionizing how researchers test new myeloma treatments. His approach is simple yet powerful, bringing the newest therapies to patients where they live rather than making them travel miles to major medical centers. For Cole, who started his career when only two myeloma drugs existed and patients survived just two years on average, the progress has been remarkable. Today there are 30 drugs available, and patients are living 10 to 15 years or longer.
Can you explain what myeloma is and why research in this area is so critical?
Multiple myeloma is a cancer of the blood cells inside the bone marrow. The bone marrow is the blood factory that makes different types of blood including red blood cells, white blood cells and platelets. One of the cells inside the bone marrow is a plasma cell. Just like a colon cell can become colon cancer or a lung cell can become lung cancer, if the plasma cell inside the bone marrow becomes cancerous, we call that multiple myeloma. Multiple means that it goes to different areas in the body, especially into the bones, so there can be holes in the bones or spots where the malignant plasma cells go. Myeloma means of the marrow, reminding us that this cancer arises from the marrow.
Multiple myeloma is the second most common blood cancer in the United States. Research is important because it disproportionately affects people of African descent. In the past, myeloma used to be a lethal cancer. As we’ve done more research, we’ve had people living longer and longer with myeloma. However, we haven’t found a cure. Now that we have gotten so much better at treating myeloma and have people living significantly longer with this disease, we’re pinning our ears back to find a cure for this type of cancer.
What is the Horizon Clinical Trial Program and how does it differ from traditional clinical trials?
We have our ears pinned back to find a cure for this disease and better treatments because we’ve gone so far from where we used to be. The Horizon Clinical Trial is unique in that we are using a drug that is very effective for myeloma. We have learned in the past that when you add drugs onto very good drugs, it makes them better and accelerates their potency.
Instead of opening one trial and then spending a year opening another one, then spending another year opening another one, we build one trial with the same platform. We use one very effective drug, and then we can add newer drugs and newer therapies to that base. It doesn’t take months and years to open trial after trial. We add onto the trial that we have. As new innovations in myeloma and new drugs come out, as new therapies arise, we can add that onto the base. It’s an adaptive platform that adapts to new therapies, which accelerates the clinical trial and our race for a cure. We can move much faster and more nimbly. Just like the trial name, we adapt to the newest things that happen, making the newest therapies accessible to patients that have the disease.
As an oncologist working with myeloma patients, what are the most challenging moments you face?
Some of the challenges with this disease are that we haven’t found a cure yet. When we have patients that have had myeloma for a long time and the therapies stop working, I really want to reach for that newest therapy but it’s not ready yet. That’s always a challenge. I know that it’s there in very early clinical trials, but how can I have my patient in front of me have access to that drug?
That’s why we have this clinical trial. I don’t have to dream about having access to a new therapy or something that may be in another country. I can have my patient have access to that trial immediately. One of the biggest challenges and one of the solutions we’ve found is having patients have access to the newest therapies. Having adaptive platform clinical trials alleviates that tough part of my job. I’m able to have my patients have access to those drugs.
What drives your passion for this work and why did you choose to focus on myeloma research?
Someone asked me this yesterday about why I do myeloma research. Throughout my life, every time somebody challenges me, I ask what’s the most difficult thing happening in a particular field. What is the biggest challenge? For some reason, that’s what I run to.
Twenty years ago, myeloma was a lethal disease. People only lived a couple years with myeloma. Now they live 10 to 15 years in some cases. Back then it was two years. I ran towards that. This obviously was an unmet need. Knowing that it disproportionately affects people of African descent, that people of African descent have twice the incidence of myeloma compared to other racial and ethnic groups, I realized it’s a hard cancer that affects my community. This is what I want to dedicate my life to.
It has been a joy seeing how we went from having two drugs for myeloma when I first started, when I had a high top fade, to now having 30 drugs for myeloma and people living way longer. We kind of see the cure on the horizon. Why do I do research in myeloma now? Because every time we do a clinical trial, we’re winning. Every clinical trial we have does something more, saves people’s lives and pushes us that much closer to a cure. What I want to do is find the cure as a myeloma community, and then I can leave myeloma and open up a pet store. I can live my life knowing that I was part of that, and my patients more importantly have benefited from us finding that cure.
When you’re talking to a patient who’s just been diagnosed, what message do you want them to hear?
When I have a patient that’s newly diagnosed with myeloma, the first thing I want to tell them is to be empowered and to know this disease. There’s a lot to know. Myeloma offers the opportunity for patients to be empowered because it’s different from a lot of cancers. The cancer cells produce a protein, and that protein tells you how much cancer you have. The higher the protein, the more cancer. When the protein goes away, the myeloma is responding. That’s very empowering for patients because they know from day to day, month to month, year to year exactly where their disease is.
I tell patients to stay current with all the research. That’s incredibly empowering because you can see the hope. You can see as the details and the therapies unfold, which brings us to people living longer with this disease and closer to curing the disease. I talk to my patients every single visit about the new things that are happening, but for them to see it themselves is incredibly empowering. You want to have control over your cancer. Cancer can be incredibly upsetting and can upend your life. What you can do by being knowledgeable, by talking to your doctor and health providers, knowing what’s happening to this disease, knowing where the protein is, you can take control over this disease and be empowered.
I tell my patients to be empowered because when you’re empowered, the disease falls into the background. The cancer’s not driving the cart, you’re driving the cart. Yesterday the only thing I did was talk to all my patients I saw. I told them these are the new things, message of hope, message of hope, message of hope, patient after patient. It’s fun for me to say that, but it’s really great to see how my patients respond to that.
For patients and families navigating a diagnosis, what advice would you give them about finding the right care team and advocating for themselves?
When you’re newly diagnosed with myeloma, it really helps to have your community hematologist-oncologist as an invaluable resource. Community doctors that know your family and the community are great resources, but they also treat lung cancer, breast cancer, colon cancer and prostate cancer. Myeloma is the second most common blood cancer, but it’s not as common as the big cancers. A community doctor may not know all the things that are happening in myeloma as fast as they’re happening.
Getting a second opinion doesn’t mean leaving your community oncologist and seeing somebody at some university. It means getting the opinion of a myeloma specialist that sits in this disease every day, is knowledgeable about the disease, especially about how fast things are moving with it, and is dedicated to keeping up with it. I’m a myeloma champion for a lot of patients where they have their community oncologist, and I advise their community oncologist about the newest therapies, about research and about delivering the best care.
Getting a second opinion and finding a myeloma champion to work with your community oncologist gives you access to clinical trials. If something were to change or if there’s a new therapy that comes out or the Horizon clinical trial is there, you have access to those newest therapies. For breast cancer, colon cancer and lung cancer, the most common ones, community doctors are up on that. Myeloma moves so fast. Engaging a myeloma specialist and seeing them maybe every three months, getting education and getting that message of hope from them is invaluable. I send my patients for a second opinion. I serve as a second opinion for a lot of patients. Hearing the message about this disease and how it works from somebody else really helps.
What do you hope the Horizon trial achieves and how will it change the landscape of myeloma research?
There are a couple things the Horizon trial has already achieved. As a health equity advisor, it has enrolled about 20% to 30% of patients who identify as Black. In previous clinical trials it’s been more like 4% or 5%. We know that 20% of patients in the United States that have myeloma are Black. Previous trials have only enrolled 4%, and we’re enrolling 20% to 30%. My first hope for the clinical trial we’ve achieved is that we have representation. When I’m in front of a patient and I say we need to do a new therapy, I want to make sure that the research has been done in patients that look like my patient. It has already achieved that.
The things that I hope it will achieve are already in the works. We’re expanding the Horizon clinical trial to community hospitals and community centers. Why should you leave your community oncologist when I can bring the trial? Why should you drive 60 miles for a clinical trial? Why don’t I just bring the trial to you? We have already taken steps and opened this clinical trial to communities where the myeloma patients are. That hope for the Horizon Trial has already been achieved.
Those are important goals, but then the next goal is that we accelerate better and better therapies to have patients live longer. By having new drugs and putting them into one of the best drugs that we have for myeloma, adding that on, seeing that synergy and then accelerating better therapies toward our cure, that’s what I dream of and have confidence in that this trial will achieve.
We need to break away from that idea that the only people who can do clinical trials are the places that have done clinical trials for 100 years. It’s almost 2026. We have the technology to bring those clinical trials to the community, and we’re doing it. That is what’s best for patient care and best to bring those clinical trials to the people who truly need it.
For people interested in learning more, where can they find you and information about the Horizon Trial?
The Multiple Myeloma Research Foundation at themmrf.org has my information and information on the clinical trial. I’m at Karmanos Cancer Center in Lansing and in Detroit. If you go to karmanos.org you can find me too. They know me at the MMRF, and I think they can lead you to me if you’re interested.