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Are You at Risk for Other Cancers While on Myeloma Maintenance Therapy?

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Published on April 27, 2016

Patient Power community member, Theresa, asks, â??Are you at risk for other cancers while on maintenance therapy? Are there any precautions I should be taking?â?? Dr. Jatin J. Shah of MD Anderson Cancer Center responds by explaining who is at risk and what screenings are necessary.

This Ask the Expert series is sponsored by the Patient Empowerment Network, which received funding from Celgene, Novartis and Takeda.

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Transcript | Are You at Risk for Other Cancers While on Myeloma Maintenance Therapy?

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That's how you’ll get care that's most appropriate for you.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

Dr. Shah, here is a question we got in from Theresa. Theresa writes, “Are you at risk for other cancers while on maintenance therapy? I’m on bortezomib (Velcade), lenalidomide (Revlimid) and dex[amethasone] (Decadron), and I also have deletion 17. Are there any precautions that I should be taking?” 

Dr. Shah:               

That’s a great question. There are a couple of questions that are even better than that. I think the first question is, are you at risk for other cancers while on maintenance therapy? So the data around that comes from the two trials where they looked at maintenance relevant after a stem cell transplant. In those two trials, where there was used maintenance therapy with lenalidomide as a single agent after transplant, there was an increased risk of second primary malignancies with the use of lenalidomide.

Now, most of those second primary cancers were skin cancers. There were a few solid tumors, as well, from breast cancer or prostate cancer or lung cancer. And there are several others, including leukemias and MDS that we saw, as well, and those are probably the most concerning. They’re very rare, but they do happen.

So I think there is an increased risk of second primary cancers that we see, but it’s really associated with when Revlimid is used after a stem cell transplant. So if you’re using Revlimid for newly diagnosed myeloma or for relapsed myeloma, we don't think there’s an increased risk of second cancers. It’s only the timing of when that’s seen immediately after a transplant that we see that increased secondary risk.

Regarding precautions to take in that setting, I think it’s important to do your normal cancer screening studies. So I wouldn’t do anything above and beyond. So make sure you see a dermatologist and getting a good skin evaluation if you see a new mole or a new lesion on the skin; make sure you get that checked out right away.

And then do your other cancer screening studies that we would normally do, like mammograms or colonoscopies, etc. So I think that’s key, is just to make sure we do our normal, routine health screening when you’re on Revlimid maintenance therapy after transplant.

If you’re on a combination of Velcade, Revlimid and dex like you mentioned, and on maintenance therapy without a transplant, there’s not an increased risk of SPMs or second cancer when you’re on that combination without a transplant; it’s just maintenance therapy, especially in somebody who has deletion 17p who maybe not have gone for a transplant in this setting. Then just continue this combination. There’s not an increased risk outside that setting.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.