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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Relapsed, Refractory Myeloma- Therapy Options

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“At the time of interim data presentation, there was no difference in overall survival between the two arms…”

Relapsed, Refractory Multiple Myeloma (RR MM) is difficult. Difficult to treat, difficult to live with, difficult emotionally, difficult in every sense of the word. It was extremely difficult for me when I first relapsed after only 10 months after my ASCT because so much of my focus was on my first remission.

The common wisdom was that a MM patient’s second remission was half as long as his first. If my first remission was only 10 months then my second remission was only going to be five months.

I figured my days were numbered…

That was then, this is now. Fortunately for RR MM patients, there is a growing list of chemotherapy regimens- doublets, triplets, vaccines, etc. to try.

Newly developed chemotherapy regimens include:

  • Immunomodulatory drugs. Thalidomide, lenalidomide (Revlimid), and pomalidomide (Pomalyst)
  • Proteasome inhibitors. Bortezomib (Velcade), carfilzomib (Kyprolis), and ixazomib (Ninlaro)
  • Monoclonal antibodies. Elotuzumab (Empliciti) and daratumumab (Darzalex)
  • Immunotherapy. Isatuximab-irfc (Sarclisa)
  • Nuclear export inhibitors. Selinexor (Xpovio)

And every new chemotherapy is trialed with other chemotherapy regimens in hopes of enhancing disease control, prolonging progression-free survival, and improving overall survival for RR MM.

To be specific:

  • Overall response rate (ORR)
  • Time to progression-
  • Progression-free survival (PFS)
  • Adverse events (AE’s aka side effects)
  • Time to next therapy-

Unfortunately for the RR MM survivor each and every chemotherapy, and each and every doublet and triplet results in more toxicity, more short, long-term and late stage side effects.

I don’t think it is a coincidence that the five most common MM symptoms are also the five most common side effects which are the five most common causes of death for MM survivors. 

The above post is critical for the relapsed, refractory MM survivor for one simply reason. Your oncologist, as knowledgable and well-meaning as he/she is, will simply prescribe more and more chemotherapy and radiation as you continue to relapse, every time your MM comes back. That is the only option available to board-certified oncologists.

The more chemotherapy you undergo-

  • the more damage (side effects) you will experience,
  • the weaker and weaker you will become and
  • the closer you get to MDR (multi-drug resistance) and
  • end-stage MM.

This is what all MM patients and survivors will face. All.

The studies linked and excerpted below put a live face on the life of the RR MM patient. Isatuximab, Carfilzomib, Pomalidomide and Dexamethasone are all being trialed as of the writing of this post in the summer of 2020.

The study authors proudly explain  how and why their chemotherapy regimens, their doublets or triplets, have advantages over all previous chemotherapy regimens. This is what conventional MM research has done for decades.

After paragraphs of action words and positive statistics both studies slip in a simple fact of MM chemotherapy-

At the time of interim data presentation, there was no difference in overall survival between the two arms…”

In other words, RR MM patients may respond (ORR), they may achieve complete, partial, remission,  they may suffer from side effects, they may experience several different outcomes but they won’t live longer.

In my view, based on years of experience and research about all things MM, the enemy is toxicity as much as it is multiple myeloma. Remember that it is toxicity that causes organ damage. And organ damage causes death.

Remember that the most common causes of MM death are the most common side effects from chemotherapy:

Whatever the RR MM survivor does, he/she must be as weary of toxicity as they are of their MM.

Integrative therapies have been shown to enhance the efficacy of chemotherapy. If you have undergone years of both Revlimid and Velcade, for example, you may no longer respond to those chemotherapies.

Consider Carfilzomib-

Then consider that Carfilzomib ” is the first and only multiple myeloma treatment that extends overall survival in the relapsed setting over the current standard of care…”

Then consider those evidence-based but non-toxic therapies that enhance the efficacy of Carfilzomib including:

I encourage the RR MM survivor to enhance the efficacy of Carfilzomib as a RR MM therapy.

Are you a RR MM survivor? What therapies have you already undergone? What, if any, side effects are you experiencing? Scroll down the page, post a question or a comment and I will reply to you ASAP.

Hang in there,

David Emerson

  • MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

Recommended Reading:

Carfilzomib or bortezomib in relapsed or refractory multiple myeloma (ENDEAVOR): an interim overall survival analysis of an open-label, randomised, phase 3 trial

Interpretation: Carfilzomib provided a significant and clinically meaningful reduction in the risk of death compared with bortezomib. To our knowledge, carfilzomib is the first and only multiple myeloma treatment that extends overall survival in the relapsed setting over the current standard of care. This study is informative for deciding which proteasome inhibitor to use for treating this disease…”

Isatuximab Plus Carfilzomib: A New Standard for Relapsed/Refractory Myeloma?

“The three-drug combination of the CD38-targeting antibody isatuximab plus carfilzomib and dexamethasone significantly improved progression-free survival (PFS) in patients with relapsed or refractory multiple myeloma, compared with carfilzomib and dexamethasone alone, according to interim analysis data from the IKEMA trial…

The phase III randomized trial included 302 patients with relapsed or refractory disease who had received 1 to 3 prior lines of therapy, excluding carfilzomib. About 25% of patients had high-risk cytogenetics…

The authors reported that the median PFS was not reached for the isatuximab group but was 19.15 months for the carfilzomib/dexamethasone group, which was similar to the estimated PFS with the two-drug regimen based on data from previous trials…

The overall response rate was 86.6% for the isatuximab combination, compared with 82.9% for the standard group…

At the time of interim data presentation, there was no difference in overall survival between the two arms…”

Daratumumab Combo Meets Primary End Point in Relapsed/Refractory Multiple Myeloma

The study is evaluating the subcutaneous formulation of daratumumab in combination with pomalidomide and dexamethasone versus pomalidomide and dexamethasone alone as treatment for patients with relapsed or refractory multiple myeloma.

The addition of daratumumab (Darzalex) in combination with pomalidomide (Pomalyst) and dexamethasone (Ozurdex) improved progression-free survival (PFS) in patients with relapsed or refractory multiple myeloma who have previously been treated with lenalidomide (Revlimid) and a proteasome inhibitor, according to the European Myeloma Network (EMN) in collaboration with Janssen…



Leave a Comment:

1 comment
Jamie Molle says 3 years ago

Thanks for the article David. I fractured my pelvis in April and am still walking with a limp. So for the first time, I am considering a ONE TIME biphosphonate drug. And my onc wants me to give Venetoclax a try next month, in a low dose (probably in combination with dex and something else). I’m already refractory to Velcaid and Carf. and Venetoclax is apparently effective for those with the 11;14 translocation, like I have. I’m dreading it.

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