Myeloma- Low-Dose Maintenance?

Dear Cancer Coach- Any Suggestions for Low-Dose Revlimid Therapy post-induction therapy of RVd (Revlimid, Velacade and Dexamethasone)?

I am writing to you today about low-dose therapy. My husband was diagnosed with multiple myeloma 08/16 and has been on the RVd (Revlimid, Velcade and Dexamethasone) regimen as his induction therapy. His m-spike is .06 and he is standard risk. We are still not considering an autologous stem cell transplant.

His oncologist suggests a low-dose maintenance of 10mg Revlimid and omitting the Velcade and Dexamethasone.

multiple myeloma in bone marrow

The other option is to continue for 2 more cycles (of RVd) to see if it has plateaued or not. The last 2 times he had a bad reaction on the Velcade, in the evening.

Do you have any recommendations? Thanks in advance.

MM Caregiver

Dear Caregiver- Several things for you and your husband to consider.

First of all, yes, low-dose Revlimid has been shown to increase the OS (0verall survival of MMers.) I will talk about possible side effects below.

Secondly, studies show no difference when a MMer has an ASCT- now or later.

Thirdly, with an m-spike of .06 your husband has responded well to his induction therapy. If this is a 90% reduction from his m-spike at diagnosis then it is a “very good partial remission” and more chemotherapy (more toxicity) may not translate into longer overall survival.

Your challenge now is to keep his MM in check for as long as possible while doing as little damage to him as possible. Conventional oncology recommends low-dose maintenance therapy to do this.

Getting back to your question about low-dose maintenance Revlimid. If your husband is experiencing any Peripheral Neuropathy now there is a good chance that low-dose Revlimid will increase the PN. Depending on how severe the PN is, reducing his dose from 10mg of Rev. to 5mg of Rev. will reduce the risk of more severe PN.

At the same time, as you read in the integrative therapy MM CC guide curcumin has been shown to enhance the efficacy of Revlimid. Also as you know from the nutrition MM CC guide anti-angiogenic nutrition will support Revlimid (also an angiogenic inhibitor).

Please watch the video below to learn more about the evidence-based, integrative therapies to combat treatment side effects and enhance your chemotherapy.

Keep in mind that curcumin is notoriously difficult to absorb. Scroll down the page to read about the most bioavailable curcumin formulas.

To Learn more about chemo for multiple myeloma- click now

Let me know if you have any questions.

Hang in there

David Emerson

MM Survivor
MM Cancer Coach
Director PeopleBeatingCancer

The Most BioAvailable Curcumin Formulas

“Based on a review of these studies, it is evident that better bioavailability of formulated curcumin (CU) products is mostly attributed to improved solubility, stability, and possibly low first-pass metabolism”

A search of the Pubmed database for the word curcumin yields 601 studies spaning health topics from multiple myeloma and colorectal cancer, to chemotherapies that synergizes with CU, to Alzheimer’s Disease, arthritis and more. Based on years of reading studies and personal accounts, I think it is safe to say that CU supplementation is safe and relatively inexpensive.

I have read about myeloma patients taking daily doses of CU from 400 milligrams to 8 grams (1000 milligrams = 1 gram). By almost any measure, CU is a safe, inexpensive wonder drug.

The only challenge is that CU is famously difficult to absorb in the body. In other words, a person has to mix curcumin with some sort of fat (coconut oil, chocolate, etc.) or take a brand of curcumin capsule that is already formulated to be more “bioavailable” in order to derive the full benefit of CU.

The study linked and exerpted below reviews different formulations of CU. The study itself lists the three most bioavailable formulation/brand of CU and I’ve added an excerpt from a further review from Consumerlab.com that lists four additional bioavailable brands of CU.

Curcumin

“CU is a bright yellow chemical produced by some plants. It is the principal curcuminoid of turmeric (Curcuma longa), a member of the ginger family, Zingiberaceae. It is sold as an herbal supplement, cosmetics ingredient, food flavoring, and food coloring.^[1]“

Bioavailable curcumin formulations: A review of pharmacokinetic studies in healthy volunteers.

“Curcumin is a widely studied natural compound which has shown tremendous in vitro therapeutic potential. Despite that, the clinical efficacy of the native CU is weak due to its low bioavailability and high metabolism in the gastrointestinal tract. During the last decade, researchers have come up with different formulations with a focus on improving the bioavailability of curcumin. As a result, a significant number of bioavailable curcumin-based formulations were introduced with the varying range of enhanced bioavailability.

The purpose of this review is to collate the published clinical studies of CU products with improved bioavailability over conventional (unformulated) CU. Based on the literature search, 11 curcumin formulations with available human bioavailability and pharmacokinetics data were included in this review. Further, the data on clinical study design, analytical method, pharmacokinetic parameters and other relevant details of each formulation were extracted.

Based on a review of these studies, it is evident that better bioavailability of formulated curcumin products is mostly attributed to improved solubility, stability, and possibly low first-pass metabolism. The review hopes to provide a quick reference guide for anyone looking information on these bioavailable curcumin formulations.

Based on the published reports,

NovaSol® (185 x),
CurcuWin® (136 x ) and
LongVida® (100 x )

exhibited over 100-fold higher bioavailability relative to reference unformulated CU. Suggested mechanisms accounting for improved bioavailability of the formulations and details on the bioanalysis methods are also discussed.”

According to Consumerlab.com:

“Novasol has the highest bioavailability (185 x compared to unforumulated CU), followed by Curcuwin (136 x), Longvida (100 x), Meriva (48 x), BCM-95 (27 x), Curcumin C3 Complex + Bioperene (20 x), and then Theracumin (16 x).”

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

Myeloma- Low-Dose Maintenance?

Dear Cancer Coach- Any Suggestions for Low-Dose Revlimid Therapy post-induction therapy of RVd (Revlimid, Velacade and Dexamethasone)?

Recommended Reading:

The Most BioAvailable Curcumin Formulas

Recommended Reading:

Curcumin

Bioavailable curcumin formulations: A review of pharmacokinetic studies in healthy volunteers.

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