Why Are Steroids Used in Conjunction With Myeloma Treatment?

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Topics include: Treatments

Why are steroids combined with standard myeloma treatment?  How do they affect you long term? Dr. Paul Richardson from Dana-Farber Cancer Institute discusses the necessity of combining steroids with therapies for multiple myeloma. Dr. Richardson addresses the side effect profile and the long-term effects of steroid use.

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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:

And I know that most of these combinations include steroids—dexamethasone (Decadron). 

So if bone marrow biopsies were our least favorite thing associated with multiple myeloma, steroids are probably our second least favorite thing associated with myeloma.  And I know that we’re taking fewer steroids now than we have in the past.  But is there any thought in terms of how long a patient should be on steroids at all? Because there can be some side effects from long-term steroid use.  Dr. Richardson? 

Dr. Richardson:

No, I think steroids are truly a case of less is more. I think you do need steroids initially, often to stabilize symptoms and control.  A high burden of disease is part of a combination, as Bob so nicely outlined.  I think though that the excitement around our combinations of immunomodulators and proteasome inhibitors is that you can afford them to dial down the steroid.  However, steroids are clearly very helpful. 

For example, we’ve learned that if you put dexamethasone with bortezomib (Velcade) on the day of it and the day after, not only do you reduce some of the immediate side effects of the bortezomib, but you can have impacts not just only on the synergy against the myeloma but also in terms of minimizing the severity of any neuropathy.

So there are effects of steroids that perhaps may not be immediately obvious to people. I think one thing to realize with steroids, as well, is it’s very important to work with your caregiver around your diet because, quite seriously, many of the psycho emotional effects of steroids are driven by fluctuations in blood sugar, fluctuations in, therefore, your insulin requirements and so forth. So there’s a complexity to steroid use that really does require a constant and detailed approach. My own approach with steroids is always to minimize them whenever possible.

And also, frankly, particularly later in the disease course, I’m very partial to actually dropping dexamethasone and exploring drugs like Solu-Medrol or methylprednisolone because I find that drug is far less added in terms of crossing the blood-brain barrier. And its psycho-emotional effects, for example, can be less. 

Jack Aiello:         

Prednisone (Deltasone) as well? 

Dr. Richardson:

Prednisone similarly. But I think the point is there are many ways you can handle steroids to minimize the psycho-emotional effects, which I think are probably the most challenging. But I think, otherwise, as Bob alluded to, we’re moving into an era where, with combination therapies, while steroids are, if you like, a kind of lubricant that help the wheels turn, the good news is that we have very good wheels that are allowing us to use fewer and fewer steroids in our therapeutic platforms.

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 September 14, 2015