Multiple myeloma treatment is determined by the extent of the disease when diagnosed and how rapidly the disease is changing (progression), along with many other factors. Treatment can slow down or stop cancer from worsening for a time, but it will not cure multiple myeloma.
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Read More- Response to induction and consolidation therapy
- Risk group
- Stage of disease at diagnosis
- Lifestyle preferences
Which Drugs are Using for Maintenance Therapy?
According to Dr. Ye, “There’s only currently one drug approved by the FDA.” This medication, Revlimid, is an oral immunomodulatory drug that’s taken once daily, in patients who have undergone stem cell transplant.While it’s only officially approved for use after transplant, Dr. Ye explains that it’s used “off-label” in other situations, including in cases where the patient may not be eligible for transplant.
Sometimes, more than one drug may be used during maintenance. This may be a combination of oral and subcutaneous drugs that are injected into the skin.
Multiple myeloma maintenance drugs include:
- Immunomodulators: Drugs that alter the immune system to target cancer cells, including lenalidomide (Revlimid) and pamolidomide (Pomalyst).
- Oral proteasome inhibitors: Drugs that block the activity of a group of enzymes that help to control cell growth and survival, including ixazomib (Ninlaro), bortezomib (Velcade), and carfilzomib (Kyprolis)
- Monoclonal antibodies: Drugs that target specific proteins on cancer cells, including Daratumumab
Doctors use what they know about your cancer to make specific recommendations about which medications are the most likely to provide maximum benefits. The goal is to extend survival while supporting a quality of life that allows you to continue to be active.
How Long Does Maintenance Therapy Last?
According to Dr. Ye, experts look at both the efficacy and side effect profile of each drug before making a decision about how long it should be used.
“Sometimes the patients cannot tolerate the drugs because of the different side effects, including low blood counts, GI toxicities, including nausea or diarrhea, or skin rashes,” Dr. Ye explains. “Maintenance therapy is actually a long-term treatment, and the tolerance is very important.”
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Another factor is the financial aspect. Some drugs may be covered by insurance, while others might not. While priority is given to the medications that show effectiveness with limited toxicity, the financial situation is also taken into consideration.
“Many patients don’t have insurance coverage, so they can not continue the maintenance therapy,” Dr. Ye adds. These three factors, along with the disease characteristics, help determine the next course of action.
Talk to Your Doctor About Your Treatment Plan
The goal of maintenance therapy is to help maintain quality of life without causing severe side effects. Therefore, it’s important to talk with their doctor about how long to continue with treatment, based on your individual case.
“We have more and more options, and hopefully we’ll have more data down the road to offer patients the best tolerable maintenance regimen,” concludes Dr. Ye.
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