Multiple myeloma treatment
Cancer therapy has taken long strides in the past century, and this has reflected on the complexity of therapeutic regimens. Cancer was originally treated in a crude manner with limited chemotherapeutic agents and surgery for solid tumors. This, however, is no longer the case and more complex and specific therapies are discovered on a near-daily basis. Multiple myeloma therapy is no different and for best results, therapy is tailored according to the patient’s condition’s severity, their age and their overall health. For best outcome, it is ideal to obtain as much response from the first round of therapy -as is the case in most malignancies-. Recurrence is usually more sever and second-line therapies are never as effective.
Generally speaking, multiple myeloma is not completely curable, but current therapies -if successful- can cause a remission and improve lifespan for patients through avoiding complications. Treatment lines include chemotherapy, immunotherapy, radiotherapy, stem cell transplantation and surgical care for select patients.
For diseases which have no cure, the general consideration is to improve the patient’s quality of life, which means that early initiation of therapy may not be the best course of action, so if you have multiple myeloma with no symptoms -as is the case in up to third of patients-, your doctor may recommend postponing your chemotherapy. Chemotherapy’s role in multiple myeloma is largely as a symptomatic treatment. It serves to decrease the number of cells of multiple myeloma “the tumor burden” to relieve symptoms resulting from their proliferation. This can be monitored by the level of protein in urine (Bence Jones proteins) or M protein in the serum.
The most commonly used chemotherapy regimen is a combination of three drugs: Vincristine, doxorubicin and dexamethasone. The last one is a steroid which is typically used in most chemotherapeutic regimens to decrease the inflammation produced from the destruction of cancer cells. Another effective triad of drugs is Thalidomide, doxorubicin and dexamethasone. Those chemotherapeutic drugs can only be used in young, overall healthy individuals.
As for old or frail individuals, therapy is mainly restricted to Thalidomide, lenalidomide, and bortezomib. They have a better safety profile and are better tolerated. The previous drugs are used to create what we call an induction therapy, that is to hit the cancer and rapidly reduce its cells, but even if induction therapy is successful, the risk of recurrence is still high, and that’s why it has to be followed by a maintenance therapy. Several regimens can be used for maintenance therapy or even for recurrent disease. They include drugs like bortezomib and thalidomide with or without corticosteroids.