What is Induction Therapy?
- Induction therapy is the first treatment you’ll get for multiple myeloma.
- Usually it involves a three drug combination, but two- or four-drug options are also available.
- You may get a stem cell transplant after several months on induction therapy.
"The first thing we try to understand is whether this patient is going to be a candidate for a stem cell transplant or not," Dr. Sumit Madan tells SurvivorNet. He’s a multiple myeloma specialist at Banner MD Anderson Cancer Center in Arizona. "And based upon that, we can tailor our therapy."
Read MoreTreatment Goals
Your doctor’s goals in treating multiple myeloma are to:- Control your cancer
- Reverse any complications you’ve already had
- Prolong your life without causing too many side effects
The process of treating multiple myeloma starts with induction therapy.
Induction Therapy: What Is It?
Induction therapy is the first treatment you get for multiple myeloma. It reduces the number of abnormal myeloma cells in your bone marrow.
Usually, you'll stay on induction therapy for a few months. If you're not a good candidate for a stem cell transplant, you might keep taking the induction therapy long-term.
RELATED: How Does Induction Therapy for Multiple Myeloma Work?
For most people who are newly diagnosed with multiple myeloma, induction therapy involves a combo of three drugs:
1. A proteasome inhibitor. Proteasomes are like your cells' clean-up crew. They sweep away extra proteins that would otherwise kill the cells. Drugs like bortezomib (brand name: Velcade) and carfilzomib (brand name: Kyprolis) block proteasomes to speed the destruction of multiple myeloma cells.
2. An immunomodulator. These drugs work on your immune system to treat multiple myeloma. Examples are lenalidomide (brand name: Revlimid) and thalidomide (brand name: Thalidomid).
3. A steroid. Corticosteroids, also known as steroids, treat cancer and bring down inflammation in your body. Dexamethasone is a steroid that doctors often use to treat multiple myeloma.
The most common three-drug regimens for multiple myeloma are:
- Velcade, Revlimid, dexamethasone (VRD)
- Velcade, Cytoxan, dexamethasone (VCD)
Studies have shown that all of these trios work well against this cancer. Your doctor will choose one for you based on factors like your health, your risks, and the type of multiple myeloma you have.
Four-Drug Induction Therapy
More recently, the FDA approved a four-drug induction therapy. It combines:
- Velcade
- Melphalan (brand name: Alkeran), a chemotherapy drug
- Prednisone, a steroid
- Daratumumab (brand name: Darzalex), a monoclonal antibody
So far, adding a fourth drug looks very promising in clinical trials. The expanded combo helps, "both in terms of the deep remissions that we are seeing, as well as the survival advantage," Dr. Madan says.
What Happens After Induction Therapy?
Once you have achieved the desired response on induction therapy, the next step is to have a stem cell transplant. To get this treatment, you'll need to be in good enough health.
After induction therapy, you'll have high dose chemotherapy to wipe out the cancer cells in your bone marrow. Then you'll get an infusion of your own healthy blood cells to replace the damaged ones. After the stem cell transplant, you'll get maintenance therapy to keep your cancer at bay.
RELATED: Treating Side Effects from Induction Therapy
If you're not a good candidate for a stem cell transplant, you may continue on a three-drug treatment. Anyone who is too elderly or frail to tolerate three drugs will instead take a two-drug combination. That will most likely be Revlimid and dexamethasone, Dr. Madan says.
Considering an Induction Treatment Strategy
Your doctor will choose the induction treatment that will give you the best outcome without causing too many side effects. It's important to ask a lot of questions during this process.
Make sure that you understand how the treatment your doctor recommends will help you. Also find out what side effects it might cause. Remember that you always have the right to ask for a different approach or get a second opinion if you're not comfortable with the treatment your doctor suggests.
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