Wendy Hu, MD
Kathryn L Hale, MS, PA-C
Clarence Sarkodee-Adoo, MD
Mary L Windle, PharmD
IN THIS ARTICLE
Other Drug Therapy
Other drugs that are standard treatments for myeloma are corticosteroids (prednisone or dexamethasone) and thalidomide (Thalomid).
Corticosteroids are powerful drugs that have many different actions, including anti-inflammatory and anti-immunity activity. They are active against myeloma and reduce production of protein M. Prednisone is usually given with melphalan. Dexamethasone can be given with chemotherapy agents or alone for people who cannot tolerate chemotherapy drugs. It is also given with thalidomide.
A nonchemotherapeutic agent, thalidomide, has been increasingly used in the first-line treatment of multiple myeloma. This is considered an immunomodulatory agent and is usually given with a corticosteroid, such as prednisone or dexamethasone (Decadron). Thalidomide's actions may include decreasing the ability of cancer spread throughout the blood (antiangiogenesis), interfering with adhesion molecules, or enhancing release of cytokines (cancer fighting substances within the body). This drug may be associated with sleepiness, constipation, venous blood clots, and numbness and tingling in the tips of the extremities. It is absolutely contraindicated in pregnancy, as it causes birth defects. The drug is dispensed through a program that ensures that physicians have educated patients about the importance of contraception when taking the drug. Usually, aspirin or low-dose blood thinners, such as warfarin (Coumadin) are given in conjunction with thalidomide and corticosteroids.
New drug therapy
A new analogue of thalidomide, CC-5013, or lenalidomide (Revimid), purportedly has fewer side effects of thalidomide and appears to be more potent than thalidomide in laboratory studies. It is also an immunomodulatory agent, which has undergone early clinical evaluation for recurrent myeloma and newly diagnosed myeloma with encouraging results. Further clinical evaluation is necessary and ongoing. It has been evaluated as part of combined therapy with corticosteroids or chemotherapy drugs. Currently, other immunomodulatory drugs for myeloma are also undergoing development.
Bortezomib (Velcade) is the first of a new class of medicines called proteasome inhibitors. Proteasome inhibitors may preferentially disrupt a cancer cell's growth. It is currently approved for refractory myeloma, which has previously been treated with two other regimens. However, promising results from early clinical trials suggest that it may be more effective when used for earlier disease. Currently, clinical trials are underway to assess results for first-line treatment, and also to evaluate combination therapy using the drug with corticosteroids, other chemotherapy drugs, and thalidomide. Other proteasome inhibitors have recently been developed and are now undergoing early clinical evaluation.
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