Maintenance Therapy for Multiple Myeloma
- Maintenance therapy is the third phase of treatment for multiple myeloma. It’s meant to prevent or delay the progression of the disease and extend life.
- There are multiple myeloma drugs available for maintenance therapy, some of which are still in clinical trials. Your doctor will help you choose the right options based on your treatment history and current health status.
- Maintenance is often given in a two or three-drug combination. As science advances, single-drug maintenance therapy is becoming more common.
“Maintenance therapy has been developed for many years,” Dr. C. Ola Landgren, Leader of Experimental Therapeutics Program & Leader of Myeloma Service at Sylvester Comprehensive Cancer Center at the University of Miami, tells SurvivorNet.
Read MoreRevlimid (Lenalidomide) as a Standard Therapy
Currently, there is only one FDA-approved maintenance therapy drug for multiple myeloma. “Lenalidomide (brand name: Revlimid) maintenance is the only FDA approved maintenance therapy at the current time. This is also the only category one maintenance therapy based on the National Comprehensive Cancer Center Network or the NCCN guidelines,” Dr. Landgren explains.RELATED: What It's Like to Take Revlimid for Multiple Myeloma
Lenalidomide is an oral drug that slows the progression of or shrinks tumors by inhibiting tumor cells from multiplying. Since around 2010, this has been a standard of care used for multiple myeloma patients throughout the United States.
“It’s usually given as a tablet once a day for three weeks. And then there is a one week break. That is the standard,” adds Dr. Landgren.
Lenalidomide maintenance treatment is typically recommended for patients who are feeling well and have minimal signs of myeloma. There is a risk with any drug, but with Revlimid, the benefit typically outweighs the risks in appropriately selected patients.
Other Drugs to Consider Using as Maintenance Therapy
Multiple drugs are currently being studied as possible maintenance therapies for multiple myeloma. “There are other drugs that are used that have lower category support,” adds Dr. Landgren.
“They include, for example, oral proteasome inhibitor, ixazomib (Ninlaro), and bortezomib (Velcade), that can be given subcutaneously every other week.”
RELATED: What is Maintenance Therapy for Multiple Myeloma?
There was also uptake on using Daratumumab, the CD 38 targeted monoclonal antibody. In addition, Dr. Landgren explains that there are ongoing trials that are combining some of these medications, including Daratumumab and Revlimid, to determine which combinations show the most promise.
It’s important to note that there isn’t one clear answer. Each patient is different and will respond differently to various drugs. It’s important to have an open discussion with your oncologist to decide which drug or drugs would be the best for you.
How Many Drugs Are Used in Maintenance Therapy?
Doctors typically factor in how you tolerated previous treatment, your current health, and lifestyle factors when selecting a drug or drugs for maintenance therapy.
Maintenance is often given in a two or three-drug combination. As science advances, single-drug maintenance therapy is becoming more common. “They many times go down to single drug maintenance therapy because they have achieved very good disease control to begin with, and can then step down successfully.”
RELATED: Monitoring Disease Progression During Maintenance Therapy
This may be dependent on the initial induction treatment and whether effective therapies are used upfront. “I think there are so many opinions on how to do things, but there are also many different patient perspectives on things. So it’s great to have options,” Dr. Landgren concludes.
Navigating treatment for multiple myeloma can be overwhelming. Having a variety of drugs available for maintenance therapy gives doctors more options to best treat each individual patient. Speak with your oncologist to discuss which drug or drugs are best for you.
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