Drug therapy to kill myeloma cells is the mainstay of treatment for myeloma. Drug therapy can cause side effects, especially when chemotherapy is involved. Potent chemotherapy drugs must be toxic enough to kill cancerous cells. At the same time, they take aim at normal cells and cause side effects. Yet, not everyone experiences side effects and people react differently.
If you're experiencing myeloma symptoms, your doctor will first decide whether you could be a candidate for stem cell transplantation. If transplantation is a viable option, you'll receive different chemotherapy drugs than you would if you were undergoing drug therapy alone. The chemotherapy drugs used before stem cell transplantation won't cause bone marrow damage.
Doctors combine up to six drugs to treat myeloma. You may be given the drugs as pills to swallow, by injection or through a catheter (a thin, flexible tube or intravenous line) surgically placed in a vein, normally in your upper chest.
Drug therapy has led to long-term remission in some patients and a temporary remission or significant slowing of the disease in other patients. As newer, more effective drugs become available, longer remission periods are becoming more common.
Drugs Used for Myeloma Treatment
Drugs regularly used to treat myeloma include:
- Bortezomib (Velcade®). FDA approved to be given by intravenous or subcutaneous injection, Velcade is used for both newly diagnosed and previously treated patients.
- Results from a randomized, phase 3 international trial conducted in 222 patients with relapsed multiple myeloma (MM) who were never treated with Velcade, showed that patients receiving Velcade subcutaneously achieved a 4-cycle overall response rate (ORR) of 43 percent and complete response (CR) rate of 7 percent, while patients receiving Velcade intravenously achieved an ORR of 42 percent and a CR rate of 8 percent. The overall safety profile was similar between the two arms. However, differences were observed in the incidence of peripheral neuropathy (PN). In the subcutaneous arm of the trial, 6 percent of patients experienced PN of grade 3 or higher, compared with 16 percent in the intravenous arm. In the subcutaneous arm, 38 percent of patients experienced PN of all grades, compared with 53 percent of patients in the intravenous arm.
- Researchers are studying Velcade in clinical trials for use with other drugs. Five-year follow-up data from the 682-patient, randomized international phase III Vista trial (the largest phase III registration trial in previously untreated myeloma patients ineligible for stem cell transplantation) demonstrated that patients treated with Velcade, melphalan and prednisone (VcMP) continued to have a significantly longer overall survival (OS) (median OS 56.4 versus 43.1 months, p<0.05) than those treated with melphalan and prednisone (MP) alone, a recognized standard of care.
- Thalidomide (Thalomid®). Thalomid comes in pill form and is swallowed. It's combined with dexamethasone (Decadron®) to treat newly diagnosed patients. Doctors are studying it to determine its effectiveness when combined with other drugs.
- Lenalidomide (Revlimid®). Revlimid is similar to Thalomid but more potent. Some studies suggest that it may be safer and work better for certain myeloma patients. It's combined with Decadron for patients who've already been treated for the disease.
- Melphalan (Alkeran®). This chemotherapy drug is sometimes combined with other drugs like Velcade, Thalomid or Revlimid.
- Bisphosphonates. Bisphosphonates such as pamidronate (Aredia®) and zoledronic acid (Zometa®) are used to stop damage to the bones. They can help relieve pain, reduce the possibility of fractures and reduce high levels of calcium in the blood. Side effects are rare but severe, including kidney damage and jawbone damage called osteonecrosis. Be sure to discuss bisphosphonates' risk factors with your doctor.
If you would like to read about these drugs individually, including information about side effects, click here.
To see a list of standard drugs and drugs under clinical study to treat myeloma, download or order The Leukemia & Lymphoma Society's free booklet Myeloma.