[Caro]

Continue with Velcade or try a new treatment?

by Caro on Tue Apr 13, 2010 8:57 am

Dear Dr. Bensinger,

I live near Frankfurt/Main in Germany. Please excuse my mistakes in English.

My partner was diagnosed in Aug. 07, aged 57, with multiple myeloma Stadium III A, IgA, LC Kappa, hat multiple Osteolyses (don't know the English expression ). Started therapy with Velcade, Cyclophosphamid and Dexamethason in a clinical trial. His response very good and he had an autologous stemm cell transplantation in Dec. He was told in Feb. 08 he ist in CR. Got a Zometa infusion every month for 2 years, now all three months.

In July 09 he had a swelling at the cheekbone and it hurt, so he had a CT. It showed a pathologic fracture of the cheekbone and a ?? weak part ?? manifestation of the multiple myeloma, also at his sacrum. MRI showed further manifestations in the thighbones. In all that time all blood counts were in good order, nothing significant for the multiple myeloma. In August 09 started new therapy with Revlimid and low dose Dexamethason. In the fourth cycle he broke out in a heavy skin rash - looked like measles, but had no fever, so Revlimid therapy was stopped. His IgG was very low, so he had infusions of privigen, human IgG. In the beginning of 2010 he became very weak. Mid of Feb. MRI showed new multiple myeloma manifestations inside the pelvic bones, ischium etc. We were so shocked - seemed that Revlimid did not work. He started therapy again with Velcade, Caelyx (liposomal Doxorubicin) and Dexa, is now in the second cycle.

By now he is still very weak, has no appetite, lost since Feb. 7 kg - his height is 1,80 m, has now 65 kg, his fingers are trembling violently. It seems his multiple myeloma became non-secretorious, because his blood counts are all normal - nothing to see of the multiple myeloma.

My question is: Would you advise to continue only with that Velcade therapy, although till now he is not better, or try to get into a trial with something new - for ex. Velcade with Vorinostat, or think about an allogeniac sct (Mini-Allo)???

We are really desperate and I fear to loose him much too early.I would be very, very thankful for any suggestion in which direction we could go to help my partner. I like our doctors, but the seem to be helpless in this situation.

Many thanks in advance and kind regards

Caro

[Beacon Staff]

Re: Continue with Velcade or try a new treatment?

by Beacon Staff on Tue Apr 13, 2010 9:36 pm

Dr. William Bensinger from the Fred Hutchinson Cancer Research Center said:

"I am sorry to hear that your partner is having so many problems with recurrent myeloma.

At the present time, the best option would be for your partner to participate in a trial of a new drug; vorinostat [Zolinza] would be one possibility. There is also a second generation proteosome inhibitor (like Velcade) that can work when patients become resistant to Velcade. It is called carfilzomib. There are also several other new drugs being tested that might be available.

If your partner's clinical condition improves and he has a suitable allogeneic donor, it might be
possible to perform such a transplant if a trial is available."

[Caro]

Re: Continue with Velcade or try a new treatment?

by Caro on Wed Apr 14, 2010 1:15 pm

Dear Dr. Bensinger,

many thanks for your quick reply. Carfilzomib is not available in Germany at the moment, but it is announced that later in this year or early next year the first trials will start. Vorinostat and some other new agents are available, so maybe we got to Heidelberg for a discussion, which new drug would be the best.

Thanks again and kind regards

Caro