Induction Therapy Options
- The first phase of treatment you will undergo after a multiple myeloma diagnosis is called induction therapy. The goal of this therapy is to reduce the number of myeloma cells within your bone marrow in preparation of a stem cell transplant (if you’re eligible).
- The specific drugs used and the number of drugs used can vary from case to case. VRD a triple regimen of Bortezomib (Velcade), Lenalidomide (Revlimid) and Dexamethasone is the standard.
- Some doctors add a fourth drug to the regimen, and clinical studies are currently looking at whether or not three or four drug regimens are best and for which patients.
The Standard Combination
Oftentimes, you'll receive a combination of multiple drugs. According to Dr. Tareq Al Baghdadi, a medical oncologist and hematologist at St. Joe’s Mercy Hospital in Ann Arbor, Michigan, the triple regimen of VRD is the “standard.”
- Bortezomib (Velcade) a proteasome inhibitor
- Lenalidomide (Revlimid) an immunomodulatory drug
- Dexamethasone a steroid
Three Versus Four Drugs
But some doctors even add a fourth drug the monoclonal antibody daratumumab (Darzalex) into the mix.
“With regards to induction therapy, three versus four drugs, there’s early data now showing that you achieve deeper responses when when you use four drugs versus three drugs, but whether that’s gonna lead to survival advantage remains to be seen and specifically which subgroup of patients will achieve that advantage,” Dr. Al Baghdadi said.
RELATED: Can Multiple Myeloma Patients Achieve a Durable Remission After Induction Therapy?
So, that’s where clinical trials looking at four versus three drugs come in.
“Is a four drug regimen preferable in high risk patient versus low risk patients or standard risk patients versus both? That’s what the current clinical trials are assessing,” he explained.
Currently, there is some variation in practice depending on where you are getting treatment. Some institutions have already moved to using daratumumab as part of a four-drug standard initial therapy, while others stick to the three-drug regiment.
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