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treatment options

TREATMENT SELECTION
07.23.11

KEY POINTS

  1. Starting Treatment
    • This means starting treatment by mouth or injection (or both), which is known to wipe out myeloma cells.
    • Since all treatments have both short and long-term side effects, any such treatment must be medically necessary, and benefits must far outweigh unwanted side effects.
    • Medically necessary means that "CRAB" or related features are having an important impact by causing bone damage, kidney or heart failure, recurrent or serious infections, or nerve/neurologic damage.
    • The intent is to start treatment when the trend of active disease is clear, but before major or irreversible damage has occurred.

  2. Treatment Philosophies
    There are two philosophies, Cure vs Control:

    • Cure- therapies directed at attempting to achieve a cure
      Cure is a hope, not a reality.  A term "functional cure" has been introduced by some who define it as complete remission lasting more than 4 years. Although this is an excellent goal within clinical trials, it unfortunately does not translate into permanent cure.  Detailed testing typically reveals that patients in complete remission have small amounts of myeloma remaining, which can lead to relapse. Advocates feel that since it can be months or years until relapse occurs, "functional cure" is a reasonable goal.

    • Control- therapies directed at achieving long-term disease control and maximum quality of life benefits
      Control on the other hand has become very much an achievable reality. With the introduction of novel drugs, such as Thalidomide, Velcade®, and Revlimid® within the last decade, long-term disease control (in remission) is a reality for many patients.

    It is important to know your doctor’s philosophy in approaching your case. The argument is about the pros and cons of ongoing therapy needed to achieve and sustain the disease with respect to the impact of therapy upon quality of remission. The overall survival benefit with both the "cure" and "control" approaches can be substantial. The controversial question is: which is currently better or preferable?

    ASH 2011 presentations that address STEP 3

    REFERENCES

    ©2011 International Myeloma Foundation

 related articles
REVLIMID®
VELCADE® (bortezomib) for Injection
Thalidomide
The Myeloma Matrix
Dexamethasone
Radiation Therapy
The Effect of Novel Antimyeloma Agents on Bone Metabolism
Managing Side Effects of Novel Agents


You might also be interested in:

REVLIMID®
REVLIMID®, a potent immunomodulatory derivative (IMiD) of thalidomide, induces apoptosis in resistant MM cell lines and patient cells and, more importantly, decreases binding of MM cells to bone marrow stromal cells.

VELCADE® (bortezomib) for Injection
VELCADE® is an antineoplastic agent available for intravenous injection (IV) use only. It has been approved by the FDA for the treatment of myeloma. Watch the "Ask the Expert" Videos from ASCO 2004 and Lymphoma Myeloma Conference 2004 on VELCADE® as treatment and in research.

Thalidomide
Helpful information about Thalidomide Therapy for patients and caregivers, including clinical trials with THALOMID®. Watch "Ask the Expert" videos from ASCO 2004 and the Lymphoma Myeloma Conference 2004.

The Myeloma Matrix
A comprehensive guide to new drugs in development for myeloma.

Dexamethasone
Dexamethasone, an adrenal corticosteroid, is used to treat multiple myeloma.

Radiation Therapy
Radiation is often used for treatment of myeloma bone disease.

The Effect of Novel Antimyeloma Agents on Bone Metabolism
XIIth International Myeloma Workshop in Washington, DC
Evangelos Terpos, M.D.
General Air Force Hospital
Athens, Greece

Managing Side Effects of Novel Agents
IMF Nurse Leadership Board Member Deborah Doss, R.N., OCN Dana Farber Cancer Institute Boston, MA