In recent years, researchers have had some notable successes in developing new treatments. People with multiple myeloma now have options that can reduce symptoms, slow disease progression, provide prolonged remission, and improve life expectancy and quality. RELATED: Cancer News Digest: The Latest Developments in Cancer Research and Treatment for February 2021
Who Should Be Treated and Who Shouldn’t
With most cancers, the general rule for treatment is “the sooner, the better.” But with multiple myeloma, physicians generally don’t treat early or asymptomatic cancer. This condition is called smoldering multiple myeloma (SMM). Of people with SMM, about 10 percent per year go on to develop multiple myeloma within five years of diagnosis. Some physicians have historically taken a “wait and watch” approach to symptoms rather than immediately prescribing medication that can cause side effects. RELATED: Everyday Health’s Cancer Disparities Twitter Chat: Here’s What You Missed Physicians generally treat patients with two or more drugs simultaneously. Some patients in intensive programs may be taking as many as six different drugs. These may be administered orally, by injection, or through a catheter surgically placed in a vein. Key medication strategies include: Chemotherapy Chemo drugs destroy cancer cells, typically by preventing them from growing and dividing. These medicines include:
Cyclophosphamide (Cytoxan, Neosar)Doxorubicin (Adriamycin, Doxil)Melphalan (Alkeran)Etoposide (Toposar, VePesid)Cisplatin (Platinol)Carmustine (BiCNU)
Chemotherapy is often one part of a regimen that includes other categories of drugs. Targeted therapy This type of medication homes in on specific genes or proteins in the cancer or in the tissues around it that help malignant cells survive. Targeted drugs block the growth and spread of cancer cells while limiting damage to healthy cells (an issue with chemotherapy drugs). Medicines include:
Proteasome inhibitors Drugs such as bortezomib (Velcade), carfilzomib (Kyprolis), and ixazomib (Ninlaro) target specific enzymes in myeloma cells called proteasomes that digest proteins in the cells.HDAC inhibitors The drug panobinostat (Farydak) is an inhibitor of the enzyme histone deacetylase (HDAC). Panobinostat helps uncoil the DNA in myeloma cells and also activates genes that stop or slow cancer cell growth.Monoclonal antibodies Elotuzumab (Empliciti) and daratumumab (Darzalex) bind to myeloma cells and mobilize the person’s own immune system to attack. These drugs also kill myeloma cells directly.Immunomodulating agents These drugs have proved effective against multiple myeloma by stimulating the immune system. Thalidomide (Thalomid), lenalidomide (Revlimid), and bortezomib are approved to treat newly diagnosed patients. Lenalidomide, pomalidomide (Pomalyst), bortezomib, carfilzomib, panobinostat, ixazomib, elotuzumab, and daratumumab treat recurrent myeloma.
Other drug therapies Patients with multiple myeloma are often treated with steroids, such as prednisone or dexamethasone, either alone or in combination therapy. Steroids can both fight inflammation and kill myeloma cells. RELATED: Sugary Drinks Are Linked to Greater Risk of Early-Onset Colorectal Cancer
Stem Cell Transplantation for Multiple Myeloma
One of the first decisions a doctor makes after giving a multiple myeloma diagnosis is deciding whether the patient is a candidate for a stem cell transplant. For some patients, such as those who have other serious medical conditions, the risk of a stem cell transplant may outweigh the benefits. But for people who are healthy enough for a stem cell transplant, this may be the treatment of choice, with the best prognosis. Stem cells are cells found in the blood and bone marrow that develop into red blood cells, white blood cells, and platelets. A stem cell transplant aims to replace cancerous stem cells with healthy ones. There are two types of transplant: Autologous transplant Doctors collect stem cells from the patient’s blood, treat the patient with high-dose chemotherapy, and return the stem cells to the patient intravenously. The stem cells make their way back to the bone marrow, where they begin to grow and multiply. Sometimes doctors recommend patients have a tandem transplant — two autologous transplants 6 to 12 months apart. RELATED: Have You Been Screened for Lung Cancer?
Radiation Therapy for Multiple Myeloma
Doctors may use radiation therapy to treat areas of bone that have been damaged by multiple myeloma, aren’t responding to chemotherapy, and are causing pain or are in danger of breaking.
Clinical Trials and Experimental Therapies
Researchers are striving to develop new treatment approaches for multiple myeloma, such as new drugs, new drug combinations, and new approaches for stem cell transplantations. Scientists are also probing the genetics of myeloma cells in order to identify standard and high-risk disease. Immunotherapy may have the potential to change the game in multiple myeloma treatment. A new drug of this type focuses on an immune-system cell called a T cell, a type of white blood cell. Chimeric antigen receptor T-cell therapy (CAR T-cell therapy) empowers T cells to fight multiple myeloma by changing them in the lab so they can identify and kill cancer cells.
