Customizing Maintenance Therapy for Multiple Myeloma
- If you have responded well to induction and consolidation therapy, you'll enter maintenance therapy as the final final phase of treatment in an effort to maintain a cancer-free status.
- Maintenance therapy should be individualized to you. It starts by choosing drugs that are effective and have the least amount of side effects. The goal is to avoid toxicities that will make you feel sick or interfere with your daily life.
- Once you've started maintenance therapy, it's crucial to keep your doctor informed of any changes in symptoms.
Doctors may use a variety of drugs depending on your age, overall health, previous treatments, and response to initial therapy. The ultimate goal of maintenance is to keep the disease under control while promoting a longer and better quality of life.
Read MoreGetting Started with Maintenance Therapy
According to Dr. Hoffman, maintenance therapy starts by choosing drugs that are effective and have the least amount of side effects. The goal is to avoid toxicities that will make you feel sick or interfere with your daily life.
“If we’re giving people maintenance therapies that are highly toxic or highly busy, we’re really not doing them a service,” Dr. Hoffman explains. Oral medications are favored because daily pills are easier to incorporate into your routine when compared to other options, such as weekly or monthly infusions.
When transitioning from consolidation to maintenance therapy, doctors will first evaluate where you started and how well you responded to prior treatment. This helps guide the next step in customizing your maintenance therapy plan for the best potential outcome.
Customizing Maintenance Therapy Based on Needs and Preferences
When thinking about your cancer treatment, you must remember that it’s a partnership between you and your doctor. It may sound like simply taking medications, but there are many factors to consider when planning maintenance therapy.
According to Dr. Hoffman, experts base your maintenances plan on several details, including:
- Your response to prior treatments
- Your risk for disease recurrence
- Your overall health
- Other factors that affect how you feel and function
“We individualize the maintenance plan for each patient,” Dr. Hoffman explains. The standard multiple myeloma patient begins maintenance with an oral drug, such as lenalidomide (Revlimid), which is a once-daily pill. “By its nature as an oral medication, it allows people to be fairly untethered to the medical practice,” Dr. Hoffman adds.
RELATED: Monitoring Disease Progression During Maintenance Therapy
High-risk patients may need a more comprehensive two-drug maintenance plan, which may include a combination of oral drugs or the addition of an injection drug, such as daratumumab (Darzalex) or bortezomib (Velcade).
Adjusting Your Maintenance Plan Based on Response
Once you’ve started maintenance therapy, it’s crucial to keep your doctor informed of any changes in symptoms. This information helps your medical team adjust your treatment plan so you can continue to live the best possible life, while also controlling your disease.
In some cases, your maintenance plan may need to be altered. Factors that contribute to a change might include:
- Toxicity
- Poor response to therapy
- An indication that the disease has returned
Throughout this time, you’ll be monitored for disease progression and recurrence. The goal is to avoid relapse for as long as possible. If your cancer does return, it’s important to take the appropriate next steps in treatment based on your medical team’s guidance.
“Again, the goal of maintenance is not to be a sick person on active therapy,” Dr. Hoffman concludes. “As long as we can get patients through that first year or two, we can pull back on maintenance if they’re not tolerating it well.”
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