First Relapse – What is Standard of Care?

Most people with relapsed multiple myeloma will receive a combination of three drugs.  Your physician will most likely try a drug your myeloma hasn’t seen before as your disease may well be resistant to the drugs used in the first treatment.

At every step of the way it is really important to point out that a good number of people do well after relapse. Dr. Jens Hillengass, Chief of Myeloma and a Professor of Oncology at Roswell Park Comprehensive Cancer Center, says “We can treat myeloma very well, even if the disease comes back, and even if the disease comes back again, and even if the disease comes back again.”

That said, there does seem to be a general consensus that a three drug combination is best, with three drugs better than two. Hillengass explains, “What we know now from a lot of research studies is that the three drug combination seems to be at the moment the best treatment, and which three drugs your doctor uses depends very much on the side effect profile from the first treatment, on other diseases you might have, on how long you’ve had until your disease came back. There are a lot of factors going into this decision.” Here are just a few of the treatments available that can be used in combination therapies for relapsed myeloma:

• Velcade (bortezomib) and Kyprolis (carfilzomib): These are proteasome inhibitors. In other words, they disrupt 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),  Immunoprin (thalidomide), and Pomalyst (Pomalidomide): These are known as immunomodulatory drugs. In other words, they activate 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.
• Dara (Daratumumab): This is known as an immunotherapy. More specifically, it is a monoclonal antibody that ‘tags’ cancer cells for recognition by the immune system.

With so many options, treatments can really be individualized to the specific patient, taking into consideration all of the prior treatments they have received and their susceptibility to side effects. “We have a lot of options to choose from and nowadays we can really individualize the treatment and give the patient something that fits very well in her or his situation,” he says.

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