Gday.
I'm currently in complete response from multiple myeloma light chain. One of my doctors wants to do everything possible to hold off relapse, and wants me to have Zometa, a bisphosphonate. A second doctor of mine prefers to let me be, which I'm inclining toward, but I might regret this when relapse does occur.
My concern is that Zometa is primarily for bone healing, and I didn't get any bone damage, so no relevance there. From what little I've read, there are major possible side effects, and only a weak indication that Zometa delays relapse.
Is there any other drug I could take to perhaps extend remission? I've searched these forums. Denosumab (Xgeva / Prolia) is discussed as an alternative, but for bone loss reasons.
Thank you.
Forums
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Re: Alternatives to Zometa to extend remission?
Hi Bushicky,
There are many discussions on this forum regarding the pros and cons of maintenance therapy and what drugs are specifically recommended. In general, an IMiD such as Revlimid (lenalidomide) is one of the more common drugs utilized for maintenance in the past few years. Some doctors also utilize proteasome inhibitors such as Velcade (bortezomib). Others has also utilized steroids such as dexamethasone or prednisone. And some doctors have used a combination of two or more of these drugs, or simply have had the patient continue their original treatment regimen. And yet others have utilized Zometa (see MRC Myeloma IX trial). Each of these drugs or drug combos have their pros and cons.
My specialist tends to lean towards recommending one or more of the drugs utilized during the original treatment phase for maintenance - the thinking being that it's generally better to go with the devil you know if it has been shown to work in the past. The major exception to this policy would be that he would not utilize a chemo agent such as cyclophosphamide for maintenance purposes. But be clear that mentioning what my specialist would likely recommend isn't meant to imply that his overall maintenance philosophy is generally shared amongst all myeloma specialists.
There are many discussions on this forum regarding the pros and cons of maintenance therapy and what drugs are specifically recommended. In general, an IMiD such as Revlimid (lenalidomide) is one of the more common drugs utilized for maintenance in the past few years. Some doctors also utilize proteasome inhibitors such as Velcade (bortezomib). Others has also utilized steroids such as dexamethasone or prednisone. And some doctors have used a combination of two or more of these drugs, or simply have had the patient continue their original treatment regimen. And yet others have utilized Zometa (see MRC Myeloma IX trial). Each of these drugs or drug combos have their pros and cons.
My specialist tends to lean towards recommending one or more of the drugs utilized during the original treatment phase for maintenance - the thinking being that it's generally better to go with the devil you know if it has been shown to work in the past. The major exception to this policy would be that he would not utilize a chemo agent such as cyclophosphamide for maintenance purposes. But be clear that mentioning what my specialist would likely recommend isn't meant to imply that his overall maintenance philosophy is generally shared amongst all myeloma specialists.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Alternatives to Zometa to extend remission?
G'day Bushicky (and Multibilly),
As Multibilly suggests, maintenance therapy would be an option for prolonging your remission.
However, I'm not sure I would consider Zometa a "maintenance therapy" option. There was a time when it was thought that Zometa might have an anti-myeloma effect. Several studies, both old and new, cast doubt on that notion (there are discussions about this elsewhere in the forum, if my memory serves right). These days, I believe the main reason Zometa is given to myeloma patients is to maintain or build bone strength, even in patients who have not experienced lesions.
Also, in the MRC Myeloma IX trial that Multibilly mentioned, Zometa was given to one arm of patients mainly to see how outcomes with Zometa compared to outcomes of another bisphosphonate, clodronic acid (Bonefos). Zometa was not viewed as a "maintenance therapy," but one of two bone-building treatment options given to patients as soon as they started in the trial.
In fact, the Myeloma IX trial was designed in part to test whether maintenance therapy with thalidomide had any effect on time to relapse and overall survival. One group of patients in the trial got thalidomide maintenance after their more intensive therapies, another did not. As in most maintenance therapy trials, the thalidomide maintenance did extend time to relapse in many patients, but it had no effect on overall survival.
This paper has more details on the design and long-term results of the study:
Morgan, GJ, et al, "Long-term Follow-up of MRC Myeloma IX Trial: Survival Outcomes with Bisphosphonate and Thalidomide Treatment," Clinical Cancer Research, Nov 2013 (full text of article)
Cheers!
As Multibilly suggests, maintenance therapy would be an option for prolonging your remission.
However, I'm not sure I would consider Zometa a "maintenance therapy" option. There was a time when it was thought that Zometa might have an anti-myeloma effect. Several studies, both old and new, cast doubt on that notion (there are discussions about this elsewhere in the forum, if my memory serves right). These days, I believe the main reason Zometa is given to myeloma patients is to maintain or build bone strength, even in patients who have not experienced lesions.
Also, in the MRC Myeloma IX trial that Multibilly mentioned, Zometa was given to one arm of patients mainly to see how outcomes with Zometa compared to outcomes of another bisphosphonate, clodronic acid (Bonefos). Zometa was not viewed as a "maintenance therapy," but one of two bone-building treatment options given to patients as soon as they started in the trial.
In fact, the Myeloma IX trial was designed in part to test whether maintenance therapy with thalidomide had any effect on time to relapse and overall survival. One group of patients in the trial got thalidomide maintenance after their more intensive therapies, another did not. As in most maintenance therapy trials, the thalidomide maintenance did extend time to relapse in many patients, but it had no effect on overall survival.
This paper has more details on the design and long-term results of the study:
Morgan, GJ, et al, "Long-term Follow-up of MRC Myeloma IX Trial: Survival Outcomes with Bisphosphonate and Thalidomide Treatment," Clinical Cancer Research, Nov 2013 (full text of article)
Cheers!
Re: Alternatives to Zometa to extend remission?
Ian,
I think the discussion you're thinking about in regard to Zometa and its (potential) anti-myeloma effect is this one:
"Zometa vs. Prolia in multiple myeloma patients" (started Feb 5, 2017)
The thread includes links to a couple of studies that call into question whether Zometa has an anti-myeloma effect.
Take care,
Cheryl
I think the discussion you're thinking about in regard to Zometa and its (potential) anti-myeloma effect is this one:
"Zometa vs. Prolia in multiple myeloma patients" (started Feb 5, 2017)
The thread includes links to a couple of studies that call into question whether Zometa has an anti-myeloma effect.
Take care,
Cheryl
Re: Alternatives to Zometa to extend remission?
Gday,
Thanks for your replies, appreciated.
I discussed this with my oncologist a few days ago. He said one big study shows Zometa is more effective as a remission-extender than other bisphosphonates. But he said he has no particular evidence of Zometa efficacy vs. no maintenance therapy at all.
Multibilly, I'll read up on Revlimid, if I end up suggesting this or any other treatment, I'd better have enough understanding to have the conversation. I'll read the Myeloma IX trial too.
Ian, thanks for the link to Myeloma IX trial. Your observation that Zometa is sometimes given even when there's no bone lesions agrees with what the doctor alluded to as well, that it might aid bone condition, even though my bones were "unaffected" I'll have to investigate that too, see if it applies to me.
Cheryl G, thank you for the forum thread link. I had a look, and there's lots of good discussion, and links to other studies and info.
I'm taking my time to digest all this stuff and make a decision, not feeling particularly brave currently.
Cheers.
Bushsicky
Thanks for your replies, appreciated.
I discussed this with my oncologist a few days ago. He said one big study shows Zometa is more effective as a remission-extender than other bisphosphonates. But he said he has no particular evidence of Zometa efficacy vs. no maintenance therapy at all.
Multibilly, I'll read up on Revlimid, if I end up suggesting this or any other treatment, I'd better have enough understanding to have the conversation. I'll read the Myeloma IX trial too.
Ian, thanks for the link to Myeloma IX trial. Your observation that Zometa is sometimes given even when there's no bone lesions agrees with what the doctor alluded to as well, that it might aid bone condition, even though my bones were "unaffected" I'll have to investigate that too, see if it applies to me.
Cheryl G, thank you for the forum thread link. I had a look, and there's lots of good discussion, and links to other studies and info.
I'm taking my time to digest all this stuff and make a decision, not feeling particularly brave currently.
Cheers.
Bushsicky
5 posts
• Page 1 of 1
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