[Gala]

Cisplatin-based multiple myeloma therapies

by Gala on Tue Feb 06, 2018 4:40 pm

Hi everyone!

My sister has been having treatments for her aggressive multiple myeloma for two years now. She is now having her third relapse. The doctors are almost out of options and are not optimistic at all. She is heavily pre-treated and her white blood cell count is consistently low. However, she is functioning well and has a lot of life in her. The plan now is to do an aggressive inpatient bridging therapy and then start a Darzalex, Revlimid, and dexamethasone or Darzalex, Velcade, and dexamethasone regimen until disease progression.

The doctors would like to do a cisplatin-based therapy first. After her first relapse prior to her stem cell transplant, my sister received EDAP (dexamethasone, etoposide, cytarabine, and cisplatin) (related forum thread). It did help at the time, but the side effects were quite dangerous and painful.

The doctors have told her that they may do either EDAP again or something called CAP (cyclo­phosphamide, doxorubicin and cisplatin), which is usually better tolerated. They asked my sister which one she would prefer. Well, she told them to make their decision for her, as she cannot think straight.

As this is now a matter of life and death for my sister, we need to tread carefully, but un­fortu­nately, we do not have plenty of time to think, because the disease is progressing and she has also soft-tissue proliferation.

The problem is that I have not found any information about using CAP for multiple myeloma. It is, for example, used for ovarian cancer (and some other cancers). This makes me worry that it may not help.

I know most common cisplatin-based protocols for multiple myeloma are VTD-PACE and DCEP.
Any thoughts? Once we are asked what we want, shall we request DCEP, for example? It’s really difficult to balance effectiveness and tolerability at this point.

Any thought on this? What are the principle differences between these several regimens that make the doctors choose one over another?