Which Myeloma Therapy Is Best for You?

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Topics include: Treatments

It’s wonderful to have a number of available myeloma treatments, but how do you choose which is best for you?  At a recent Patient Power myeloma forum, Dr. Robert Orlowski from MD Anderson Cancer Center explained the different types of therapies available including how the drugs work and the benefit to patients.

Sponsored by Patient Empowerment Network through educational grants from Onyx Pharmaceuticals, Novartis, and Millennium: The Takeda Oncology Company.

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Transcript

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.

Jack Aiello:

Today, you’ll find there are lots of treatments. So when I meet with new patients, I’ll say there’s good news and bad news: good news, lots of treatments to help you manage your disease for as long as possible; bad news, lots of treatments when you have no idea what necessarily is best for you. So can we talk about what might be best for you in terms of the treatments that are listed here, for example, the drug therapies, Dr. Orlowski? 

Dr. Orlowski:

Well, for people with newly diagnosed myeloma who have symptomatic disease where we recommend treatment, there are a couple of options. But if people are fit, probably most folks in the field would recommend a combination of three drugs.

One of the drugs usually would be proteasome inhibitor, which would be either bortezomib  (Velcade®) or maybe a newer drug called carfilzomib (Kyprolis®). A second drug in the three-drug combination would be one of the immunomodulatory drugs that are listed here. There are three of them approved: there’s thalidomide (Thalomid), lenalidomide (Revlimid®) and pomalidomide (Pomalyst®).

In the U.S., we most commonly, for newly diagnosed patients, use lenalidomide, along with bortezomib. And then often we throw in steroids, because first of all they have activity against myeloma by themselves. They add to the efficacy of some of the other drugs, and they may help some of the symptoms.

They can be a little bit beneficial for things like fatigue and also maybe for a poor appetite. Although, they have some downsides as well. But with that kind of three-drug core regimen, the response rates for newly diagnosed patients are approaching 100 percent. The response doesn’t necessarily mean that the myeloma is gone.

Out of those almost 100 percent, about one-third have what’s called a complete remission, meaning that you can’t detect the myeloma protein in the blood or urine. And you can’t find it in the bone marrow on a regular bone marrow aspirate.

About one-third have what’s called a very good partial remission, which means at least a 90 percent reduction, but not quite to 100 percent. And another third have between a 50 to a 90 percent reduction. Obviously, we’d like for those all to be 100 percent complete remissions, which is why there are some clinical trials in some cases where we try to do better than that one-third of people in complete remission.

And for people who are then candidates for stem cell transplant, which is quite a few people, you can be a candidate even if you’re over 65, over 70, in some cases even over 75, as long as your overall health is good. And the transplant is often used to try to get additional reduction of the amount of myeloma disease burden.

It’s important, though, unfortunately, to remember that even people in complete remission, still probably have some leftover myeloma. And maybe we’ll have time later to chat about what’s called MRD, or minimal residual disease testing, which are some newer techniques that are being developed and some of them are now available, that look to detect even very small amounts of myeloma that may be missed on a plain bone marrow aspirate.

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.

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Page last updated on January 21, 2015