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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Velcade, Myeloma Induction
“Failure (of the multiple myeloma patient) to respond to a bortezomib-based induction was found to be an independent risk factor for mortality.”
When my oncologist prescribed a triplet for my induction therapy, it never occurred to me that I wouldn’t “respond.” I don’t think any newly diagnosed multiple myeloma (MM) patient begins induction therapy thinking that there is even a chance that he/she might not achieve at least some sort of remission from an induction that includes velcade (Bortezomib).
I received my medical file in 2017, almost 20 years after I concluded my conventional therapies. The oncologist who was in charge of my autologous stem cell transplant made a small hand-written that I had reached stage 2B after my initial diagnosis of non-secretory MM a year and a half previously and after I had just undergone five rounds of induction therapy. Needless to say, I did not respond to my induction therapy.
If you’re reading this blog post it may be because you have not responded to your Bortezomib-based induction therapy either.
Several things to consider. First and foremost, there is a long and growing list of standard-of-care chemotherapy regimens that your oncologist will recommend to you as “salvage” therapy. Keep in mind however, that according to the study linked and excerpted below, the fact that you don’t respond to bortezomib based induction therapy indicates that your survival is, on average, inferior.
Consider those evidence-based, non-toxic therapies shown to be cytotoxic to multiple myeloma. In other words, consider therapies shown to integrate or enhance the efficacy of MM therapies such as Revlimid (lenalidomide) or kyprolis (carfilzomib).
The important thing for you to remember is that multiple myeloma is a complex blood cancer. Conventional oncology can’t understand every aspect of MM management. Consider those therapies that have kept me around since 1994.
Have you been diagnosed with multiple myeloma? To learn more about both conventional and evidence-based non-conventional therapies, scroll down the page, post a question or comment and I will reply to you ASAP.
Thank you,
David Emerson
- MM Survivor
- MM Coach
- Director PeopleBeatingCancer
Recommended Reading:
- Multiple Myeloma- How to Find and Work with the Best MM Specialists
- Myeloma Symptoms at Diagnosis-
- Do Oncologists Pressure Myeloma Patients to Participate in Clinical Trials?
“RESULTS- Two hundred and ninety five patients met inclusion criteria and 74 (25%) were non-responsive to bortezomib-containing induction. Non-responsive patients were older, more anemic and had more often ISS-3, del17p and ECOG performance status 2-4 (table 1). Notably, these patients received less often a bi-weekly bortezomib schedule, a triple-drug regimen and high dose melphalan treatment at first line…
2ndPFS in patients who received salvage second line therapy immediately following induction failure was similar to that measured in bortezomib-responsive patients receiving 2nd-line therapy for disease progression, approaching 14 months. However, survival from time of salvage 2nd-line treatment was significantly lower among patients non-responsive to bortezomib-based induction compared to that measured in responsive patients (25 months vs. not reached, respectively, p=0.024; Fig. b).
CONCLUSIONS- Failure to respond to a bortezomib-based induction was found to be an independent risk factor for mortality. Despite the non-inferior 2ndPFS reported in these patients as compared with their bortezomib-responsive counterparts, survival remained significantly inferior. Possibly this difference is because non-responsive patients are less likely to respond to further proteasome inhibitor therapy at following relapses. Randomized controlled trials are needed to test whether intensification of induction and/or of further treatment may improve the poor prognosis of patients who fail to respond to bortezomib-based induction.
Update on the optimal use of bortezomib in the treatment of multiple myeloma
“The proteasome inhibitor (PI) “bortezomib” has now been in routine clinical practice for over a decade. It is now considered an important backbone therapy for all stages of the disease, and data continue to grow to support its use in newly diagnosed patients, relapsed and relapsed/refractory disease, maintenance therapy, high risk, and renal failure.
Much has been learnt about the most clinically effective way of delivering therapy, with patients often benefiting more from a triplet bortezomib combination compared to a doublet combination. It is well tolerated and can be administered in the outpatient setting with manageable toxicity. The key to good results is managing side effects so that patients remain on therapy with minimal interruptions. Therefore, proactive management of peripheral neuropathy and thrombocytopenia is advised using dose delay and reduction strategies…
Conclusion
The introduction of bortezomib for the treatment of myeloma has been one of the major breakthroughs in the care of patients with hematological malignancies in the past decade. Although the drug was first studied in the relapsed myeloma setting, its use quickly spread to the newly diagnosed transplant-eligible and transplant-ineligible setting, and it is now considered an important backbone therapy for all stages of the disease.
In addition, data now support its use in Waldenstrom macroglobulinemia and other subtypes of lymphoma. Due to its novel mechanism of action and manageable side effect profile, it is effective in the treatment of high-risk myeloma disease subgroups:
- frail,
- elderly,
- renal failure, and
- poor-risk genetics
Much has been learnt about the most clinically effective way of delivering therapy, with patients often benefiting more from a triplet bortezomib combination compared to a doublet combination.
As with any therapy, managing side effects quickly and efficiently when they occur is important, so that patients can continue on treatment and benefit from therapy. Therefore, proactive management of peripheral neuropathy and thrombocytopenia is advised using dose delay and reduction. The recent introduction of second- and third-generation PIs with different chemical and biological properties has resulted in a plethora of new clinical studies and has confirmed the ongoing role of this class of drug in future therapy.”