The course of multiple myeloma is usually one that cycles through periods of remission and relapse. But with each subsequent relapse, the challenge to treat the disease effectively grows more complicated.
Dr. Matthew Pianko, a hematologist with the Rogel Cancer Center at the University of Michigan in Ann Arbor, explains that despite the variety of drugs available to fight this treatable but incurable blood cancer, a second or third relapse can indicate some medications may not be appropriate anymore in trying push the disease back into remission.Read More
In recent years, the use of monoclonal antibodies to treat subsequent relapses has become more popular. Antibodies are proteins created by the body's immune system to fight infections. Monoclonal antibodies are synthetic versions that can zero in on targets such as the proteins on the surface of myeloma cells. One of the most widely used monoclonal antibodies in the treatment of subsequent multiple myeloma relapses is daratumumab (Darzalex). Other drugs in this class that are used to treat multiple myeloma include isatuximab (Sarclisa) and elotuzumab (Empliciti).
"When considering what new option to consider at relapse, we look to a patient’s prior treatment history to make a decision about what type of therapy is most appropriate at this time," Dr. Pianko says. "Where possible, we try to include to include at least two new drugs that the patient’s disease has not been yet treated with, however drugs can be re-used for treatment of myeloma that a patient may have received in the past."
Familiar or New Medications
Dr. Pianko adds that the decision to reuse a particular drug will depend on how well the patient responded to that medication the first time and how long it has been since the drug was last used. "Other factors might relate to the current situation that a patient’s inhow is their disease behaving? Do they have any other reasons that might make a drug appealing or less appealing based on that side effect profile? Trying to tailor the treatment of the disease to each particular patient could also impact whether or not reuse of a drug that has been used successfully in the past to treat a patient is considered appropriate."
For patients who have become resistant to certain medications or intolerant of various cancer drugs, participating in a clinical trial of an experimental drug may be an option. New drugs are being developed at a fairly rapid rate, so patients may be able to effectively treat a relapse with a drug or drug combination that has yet to be approved.
New monoclonal antibodies and CAR T-cell therapies are among the most promising agents in early trials. If you are interested in participating in a clinical trial, talk with your doctor. There may be a research institution in your area that is recruiting patients or you may be eligible for a trial that may require some travel. Researchers have specific criteria for the patients they select for clinical trials, but if you are interested, it may be worth your time to investigate whether you fit their profile.