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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SOC or CAR-T in RR/MM Patients-
What is more effective SOC or CAR-T in RR/MM patients? SOC is short for “standard-of-care” and RR/MM is for “relapsed refractory multiple myeloma.”
When the newly diagnosed MM patient is first diagnosed, they usually undergo the standard-of-care therapy plan for NDMM of:
- Induction Therapy
- Autologous Stem Cell Transplant
- Low-dose Maintenance Therapy
While you and your oncologist may make minor changes to this basic FDA approved therapy plan, the SOC is well-defined and promoted by most every oncologist.
Once a MM patient relapses after they undergo the basic therapy plan, what do they do? There are a growing number of therapies to choose from.
Drs. Raje, Fonseca and Anderson do an excellent job of explaining RR/MM thinking-
What are the standard of care chemotherapy combinations prescribed once a myeloma patient relapses?
1. Proteasome Inhibitor-Based Combinations
- Carfilzomib + Dexamethasone (Kd) or Carfilzomib + Lenalidomide + Dexamethasone (KRd): Carfilzomib is often used in patients who have relapsed after initial therapy and can be combined with lenalidomide or dexamethasone alone.
- Ixazomib + Lenalidomide + Dexamethasone (IRd): Ixazomib, an oral proteasome inhibitor, is combined with lenalidomide and dexamethasone as a convenient, all-oral regimen.
2. Immunomodulatory Drug (IMiD)-Based Combinations
- Pomalidomide + Dexamethasone (Pd) or Pomalidomide + Bortezomib + Dexamethasone (PVd): Pomalidomide is an option for patients who have already been treated with lenalidomide and proteasome inhibitors.
- Lenalidomide Rechallenge: For patients who responded well to initial therapy with lenalidomide, this drug may be reintroduced in combination with other agents.
3. Monoclonal Antibody-Based Combinations
- Daratumumab Combinations:
- Daratumumab + Carfilzomib + Dexamethasone (D-Kd)
- Daratumumab + Lenalidomide + Dexamethasone (D-Rd)
- Daratumumab + Pomalidomide + Dexamethasone (D-Pd): Daratumumab, an anti-CD38 monoclonal antibody, can be combined with various regimens.
- Elotuzumab + Pomalidomide + Dexamethasone (E-Pd): This is another monoclonal antibody targeting SLAMF7, used in patients with relapsed/refractory myeloma.
4. Chemotherapy-Based Combinations
- Cyclophosphamide + Bortezomib + Dexamethasone (CyBorD): This combination can be used for patients who need a more aggressive approach, especially those who have limited other options.
My thinking is clouded by my own MM experiences. I underwent the new therapy that was supposed to cure my MM. No, my ASCT did not cure me…
Going by my experience, anti-BCMA therapies, especially CAR-T cell therapies are new and bring serious risks of short, long-term and late stage side effects. Therefore, my thinking is to undergo one or more of the chemo cocktail listed above.
Email me at David.PeopleBeatingCancer@gmail.com with your questions-
thank you,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Ide-cel or Standard Regimens in Relapsed and Refractory Multiple Myeloma
BACKGROUND
Survival is poor among patients with triple-class–exposed relapsed and refractory multiple myeloma. Idecabtagene vicleucel (ide-cel), a B-cell maturation antigen–directed chimeric antigen receptor (CAR) T-cell therapy, previously led to deep, durable responses in patients with heavily pretreated relapsed and refractory multiple myeloma.
METHODS
In this international, open-label, phase 3 trial involving adults with relapsed and refractory multiple myeloma who had received two to four regimens previously (including immunomodulatory agents, proteasome inhibitors, and daratumumab) and who had disease refractory to the last regimen, we randomly assigned patients in a 2:1 ratio to receive either ide-cel (dose range, 150×106 to 450×106 CAR-positive T cells) or one of five standard regimens. The primary end point was progression-free survival. Key secondary end points were overall response (partial response or better) and overall survival. Safety was assessed.
RESULTS
A total of 386 patients underwent randomization: 254 to ide-cel and 132 to a standard regimen. A total of 66% of the patients had triple-class–refractory disease, and 95% had daratumumab-refractory disease. At a median follow-up of 18.6 months, the median progression-free survival was 13.3 months in the ide-cel group, as compared with 4.4 months in the standard-regimen group (hazard ratio for disease progression or death, 0.49; 95% confidence interval, 0.38 to 0.65; P<0.001). A response occurred in 71% of the patients in the ide-cel group and in 42% of those in the standard-regimen group (P<0.001); a complete response occurred in 39% and 5%, respectively. Data on overall survival were immature. Adverse events of grade 3 or 4 occurred in 93% of the patients in the ide-cel group and in 75% of those in the standard-regimen group. Among the 225 patients who received ide-cel, cytokine release syndrome occurred in 88%, with 5% having an event of grade 3 or higher, and investigator-identified neurotoxic effects occurred in 15%, with 3% having an event of grade 3 or higher.
CONCLUSIONS
Ide-cel therapy significantly prolonged progression-free survival and improved response as compared with standard regimens in patients with triple-class–exposed relapsed and refractory multiple myeloma who had received two to four regimens previously. The toxicity of ide-cel was consistent with previous reports. (Funded by 2seventy bio and Celgene, a Bristol-Myers Squibb company; KarMMa-3 ClinicalTrials.gov number, NCT03651128.)
SOC or CAR-T in RR/MM patients