What I wish I knew about Multiple Myeloma treatments 25 years later...

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Multiple Myeloma- The Cure vs. Control Debate

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Although not often openly acknowledged, “cure vs control” is the dominant philosophical difference behind many of the strategies, trials, and debates related to the management of myeloma.

You have been diagnosed with incurable cancer with an average survival, according to the American Cancer Society, of 5-7 years depending on the stage at diagnosis.Your challenge as a newly diagnosed myeloma patient is to weigh the pros and cons of each approach. I am both a long-term multiple myeloma survivor and a multiple myeloma cancer coach. 

Please watch this video of Dr. Tom Martin and listen for this comment

  • At the 1: 00-minute mark you will hear Dr. Martin say “Is the myeloma causing end-organ damage? Not every myeloma patient needs treatment.”
  • At the 4: 00-minute mark you will hear Dr. Martin discuss either/or the aggressive, toxic cure approach or the less aggressive control approach in multiple myeloma therapy.

While Dr. Martin does not come out an say so, he clearly cautions myeloma patients to consider all therapy regimens and not to simply jump into a stem cell transplant.

I have remained in complete remission from my multiple myeloma since April of 1999 by living an evidence-based, non-toxic, anti-MM lifestyle through nutrition, supplementation, bone health, mind-body, lifestyle, and more. I believe that multiple myeloma patients must use the best of both conventional (FDA approved) and non-conventional myeloma therapies.

In the article linked and excerpted below, Dr. Vincent Rajkumar presents a convincing and thoughtful discussion that all myeloma patients should read before therapy begins. Further, if a myeloma patient considers supplementation, nutrition and lifestyle therapies that have bee shown to have anti-cancer or anti-myeloma properties then Dr. Rajkumar’s argument for myeloma control is even more credible.

Have you been diagnosed with multiple myeloma? If so, what stage? Are you experiencing any side effects such as bone damage, anemia or kidney involvement? Scroll down the page, post a question or comment and I will reply to you ASAP.

Thank you,

David Emerson

  • MM  survivor,
  • MM Cancer Coach
  • Director PeopleBeatingCancer

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Treatment of Myeloma: Cure vs Control

“Although not often openly acknowledged, “cure vs control” is the dominant philosophical difference behind many of the strategies, trials, and debates related to the management of myeloma. Should we treat patients with myeloma with multidrug, multi-transplant combinations with the goal of potentially curing a subset of patients, recognizing that the risk of adverse events and effect on quality of life will be substantial? Or should we address myeloma as a chronic incurable condition with the goal of disease control, using the least toxic regimens, emphasizing a balance between efficacy and quality of life, and reserving more aggressive therapy for later?..”

Cure or Control?

The cure-vs-control debate colors the approach to the treatment of smoldering (asymptomatic) disease, duration of therapy, choice of drugs, and many other clinical decisions in myeloma. It also substantially affects the interpretation of study results and the approach to the care of patients with myeloma.

So, should it be cure or control for myeloma? In the setting of designing and conducting clinical trials, both strategies should be explored simultaneously. Some patients desire a potentially curative approach and are not greatly concerned about the risk of adverse events, whereas others think the quality of life is more important than overall survival and are unwilling to risk their quality of life for a potential cure. Having clinical trials available to cater to both types of patients is important. For example, the Mayo Clinic myeloma group is currently pursuing an approach with single-agent lenalidomide as initial therapy for myeloma with other drugs added as needed, with an emphasis on quality of life and disease control. At the same time, we are testing a multidrug combination strategy with 4 active agents in the attempt to develop a curative “myeloma CHOP (cyclophosphamide-hydroxydaunomycin [doxoru-bicin]-vincristine [Oncovin]-prednisone)” regimen; the CHOP regimen has been used successfully to cure large cell lymphoma. Thankfully, many centers have a similar selection of trials targeting both options.

Outside of a clinical trial setting, I prefer disease control as the treatment goal, except in selected high-risk patients in whom an aggressive approach to achieving CR may be the only route to long-term survival. The disease control approach involves targeting very good partial response (minimal residual disease) rather than CR as a goal; using limited, less intense therapy first and moving to more aggressive approaches as need arises (sequential approach); allowing patients to help determine the timing and number of transplants (patient choice); and avoiding allogeneic transplant. Although cure is the ultimate goal of our long-term research, we need more data from randomized trials before resorting to highly intense therapy that is more toxic and unlikely to lead to a cure outside the setting of a clinical trial. On this one point, proponents of both cure and control can agree.”

 

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