Multiple Myeloma

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Options for Treatment During the Maintenance Phase

Dr. Adam Cohen University of Pennsylvania

So what happens when different treatments have reduced the cancer? You will enter the next phase of myeloma treatment, the maintenance phase.

The goal of the first two phases is to get rid of as many cancerous cells as possible. Oncologists do this by administering a cocktail of drugs and a round of high dosage chemotherapy which is followed by a stem-cell transplant. The stem cells replenish healthy cells. Once patients are finished with these first two phases, they will enter a third phase with a different goal. Now that the first two phases have attacked the cancer, the third phase seeks to to maintain the depleted state of cancerous cells in the body for as long as possible.

The most effective drug to take during the maintenance phase is low-doses of Revlimid (lenalidomide). This drug activates the cells in our immune system that are responsible for killing off bacteria, viruses, and cancers. It also reduces vital blood flow to cancerous tumors, helping kill them off. However, some patients don’t tolerate lenalidomide well because of some of its potential side effects, including nausea, vomiting, swelling of the limbs and skin, and liver problems. So there’s an alternative. Very recent studies have shown that the best alternative to lenalidomide is Velcade, a proteasome inhibitor.

Velcade (bortezomib) has similar cancer-fighting properties but instead of activating the immune system it blocks the ability of cancer cells to properly process and release excess proteins as waste. Thus, unnecessary proteins build up in cancerous plasma cells and eventually cause them to die off.

Although Velcade is a viable alternative to lenalidomide during the final phase treatment, lenalidomide should still be the first option for patients who tolerate its side effects well, says Dr. Adam Cohen, hematologist-oncologist at the University of Pennsylvania. “We don’t think it’s going to replace lenalidomide. The head-to-head data really isn’t available yet, but I do think [Velcade] is an important…alternative option for patients.”

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Dr. Adam Cohen is a Hematologist-Oncologist and Assistant Professor of Medicine at the Hospital of the University Of Pennsylvania Read More

Multiple Myeloma: Maintenance Treatment

In some cases, multiple myeloma patients will be put on something called maintenance therapy after initial treatment, in order to “maintain” myeloma in a depleted state.