An Alternative Treatment for Relapse

Despite all of the innovative and diverse treatments that oncologists employ to treat myeloma, it can come back, or relapse. This is because not every myeloma cell in your body is exactly the same, and so not all will respond in equal ways to treatment. Some start out with a set of mutations that can give them resistance to treatments and make them more likely to relapse, whereas others develop mutations as a result of treatment.

The goal in relapsed myeloma is to use treatments that were not used after the initial diagnosis. The logic behind this approach goes something like this: because myeloma cells that relapse survived that treatment, they are likely now resistant to it, so attacking the myeloma using a new drug will prove more effective.

Patients with newly diagnosed myeloma typically undergo a three-drug regimen known as VRD therapy, consisting of:

• Velcade (bortezomib): This disrupts the mechanism by which cancer cells break down proteins. This build-up of protein within the cell eventually causes the cells to die.
• Revlimid (lenalidomide): This is known as an immunomodulatory drug. In other words, it activates your immune system to target cancer cells and kill them like they would any other infection.
• Dexamethasone: This is a steroid drug that prevents inflammation and associated pain from myeloma, and it can even help kill myeloma cells at high doses.

In patients with relapsed myeloma, the classes of drugs given doesn’t change, but the drugs themselves do. This is because the cancer cells are still susceptible to being attacked via the same methods, they just must be given drugs for which they are not resistant to. For relapsed myeloma patients, the three-drug regimen is known as KPD therapy, consisting of:

• Kyprolis (carfilzomib) – As an immunomodulatory drug, its function is very similar to Revlimid, but it has been found to causes less neuropathy, or nerve pain, and also is more potent and effective in high-risk patients.
• Pomalyst (pomalidomide) – Its function is very similar to Velcade.
• Dexamethasone – A mainstay of myeloma treatment in both relapsed and initially diagnosed patients.

Although some oncologists disagree on this point, Dr. Sagar Lonial, Chief Medical Officer at the Winship Cancer Institute of Emory University, believes that the most effective triplet therapy in relapsed patients–particularly high-risk relapsed patients–is KPD therapy. “What we know is, that these aggressive high-risk relapses seem to be more sensitive to [KPD therapy] than they would to other potential triplets.”

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