Recently Diagnosed or Relapsed? Stop Looking For a Miracle Cure, and Use Evidence-Based Therapies To Enhance Your Treatment and Prolong Your Remission

Multiple Myeloma an incurable disease, but I have spent the last 25 years in remission using a blend of conventional oncology and evidence-based nutrition, supplementation, and lifestyle therapies from peer-reviewed studies that your oncologist probably hasn't told you about.

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Multiple Myeloma- Darzalex Best Among All Triplet Combinations

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Since only two agents were found to add a significant cost-effective value to multiple myeloma regimens, the researchers highlighted the need for improved value for this patient population.

When someone is diagnosed with multiple myeloma, most patients have one main goal. Complete remission. All we want to do is kill as much of our blood cancer as we can. We’ve been told that our cancer is incurable but very treatable.

By “treatable” we think that we have to endure lots of toxicity. We are willing to undergo all of the side-effects as long as we go into a real remission. Oncology can’t guarantee a real remission but we all hope for the best despite the averages.

At least that was my goal when I began my induction therapy in preparation for my autologous stem cell transplant (ASCT) in 1995.

Since induction therapies have gotten pretty good at achieving a response in newly diagnosed MMers, that one goal works. If an MMer undergoes induction therapy followed by an ASCT  he/she has a pretty good chance of achieving a CR or VGPR.

But what happens when you relapse after your first remission? I don’t mean a monthslong or even a couple year long remission. What happens when someone relapses after 5 or 6 years?

The article linked below talks about both how the relapsed/refractory MMer responds as well as how cost effective that response is.

A few months after my diagnosis of MM, the bills began to arrive. I had good health insurance so I didn’t think that I had much to worry about. Boy, was I wrong.

Skip from then, 1995 to today, 2019. Most health plans require a 10%-20% copay. Many multiple myeloma chemotherapy regimens are thousands of dollars a month.  Even if the co-pay is only 10%-20% you end up paying a lot of money between remissions and relapses.

What would happen if you asked your oncologist about the “costs and outcomes achieved” for the chemotherapy triplet he/she had just recommended? My guess is that your oncologist won’t like being asked anything about the cost of chemotherapy, in dollars. But keep in mind, your oncologist is making money on whatever therapy you undergo.

In my view, you, the patient, are entitled to ask about your chemotherapy and concepts like “quality-adjusted life-years.” 

I am both a MM survivor and MM cancer coach. I don’t expect the newly diagnosed myeloma patient to understand concepts like the ones discussed in the post. But I do think discussing these issues with your oncologist can make a huge difference to your pocketbook and possible survival.

The MM Cancer Coaching program outlines the conventional and non-conventional issues that can make a tremendous difference in your life as a MMer.

Scroll down the page to ask any and all questions. I will reply to you ASAP.

Thank you,

David Emerson

  • MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

Recommended Reading:

Despite Clinical Efficacy, Only Certain Myeloma Treatments Are Cost-Effective

“The addition of Darzalex (daratumumab) and Farydak (panobinostat) appeared to be the most cost-effective regimen to treat multiple myeloma, according to a recent analysis published in the Journal of Managed Care & Specialty Pharmacy.

Over the past few years, the Food and Drug Administration (FDA) has approved a variety of triplet combinations for the treatment of patients with multiple myeloma. However, little is known which regimens have the best economic impact, without sacrificing clinical outcomes that is.

“The increasing cost of U.S. health care, and specifically for cancer, has generated renewed discussion about the value of medical technologies,” the researchers wrote. “The availability of effective treatment options for multiple myeloma patients is of paramount importance. However, in an era of continuing increases in health care spending and drug prices, it is also important to understand the relationship between costs and outcomes achieved.”

The study – conducted by researchers from the University of Washington in Seattle and from the Institute for Clinical and Economic Review in Boston – evaluated the cost-effectiveness of treatments for relapsed and/or refractory multiple myeloma using a partition survival model that they had developed.

The model included three health states –

  • progression-free survival (PFS),
  • disease progression and death –

to help compare

  • Kyprolis (carfilzomib),
  • Empliciti (elotuzumab),
  • Ninlaro (ixazomib),
  • Darzalex and
  • Farydak,

all in combination with either Revlimid (lenalidomide) or Velcade (bortezomib) plus dexamethasone in the second or third line of therapy.

Meanwhile, model costs included in the analysis were those related to drug treatment, administration, monitoring, adverse events, and progression.

Regimens containing Darzalex produced the best clinical results, demonstrating the highest expected life-years, which ranged from 6.71 years to 7.38 years, as well as the highest quality-adjusted life-years among all of the triplet combinations.

The most cost-effective regimens were Darzalex plus Velcade and dexamethasone in the second line and Farydak plus Velcade and dexamethasone in the third line. However, the researchers cautioned that the interpretation and applicability of the Farydak regimen may be challenging because of ongoing toxicity concerns.

“The analyses reported here reveal that important advances in the treatment of relapsed and/or refractory multiple myeloma have been made over the past decade, which has expanded treatment options and improved patient outcomes,” the researchers wrote. “However, only a few regimens have done so in a cost-effective manner.”

Since only two agents were found to add a significant cost-effective value to multiple myeloma regimens, the researchers highlighted the need for improved value for this patient population.

“Achieving levels of value more closely aligned with patient benefit would require substantial discounts for the remaining agents evaluated.”

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Relapsed/Refractory Multiple Myeloma- Efficacy, Cost, AE's - PeopleBeatingCancer says 4 years ago

[…] Multiple Myeloma- Darzalex Best Among All Triplet Combinations […]

End-Stage Multiple Myeloma- Choices? - PeopleBeatingCancer says 4 years ago

[…] Multiple Myeloma- Darzalex Best Among All Triplet Combinations […]

Larry Pelton says 6 years ago

Hi David. I just learned about you and your MM coaching, so here’s my first question:
After reading about treatments said to be most cost effective, I’m wondering if the findings might be different depending on specific genetic markers.

    David Emerson says 6 years ago

    Hi Larry,

    The study referenced in my post focuses on a group of MMers and average PFS, OS, etc. So yes, you are correct. Any one individual MMer can have a better or worse reaction to his/her chemotherapy regimen. It is pretty well established that, for example, 4,14 deletion, etc. worsen overall survival in MM.

    Are you an MMer with a genetic abnormality? If so, which one?

    David Emerson

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