[Ruchi]

Re: CyBorD when no longer responding to VRD or KRD?

by Ruchi on Thu Apr 11, 2019 9:43 pm

Namaste Nancy.

So my mother opted for Kyprolis, bendamustine, and dexamethasone regimen instead of pomalidomide, doxorubicin, and dexamethasone regimen as she was afraid doxorubicin would make her lose her hair. I read somewhere that if doxorubicin is given weekly on low doses it might not cause hair loss, but the doctor was talking about giving it every 21 days, which we presumed might be high dose. Also the doctor agreed when we mentioned hair loss as a possible side effect of doxorubicin.

We are trying to make mother understand she can use wigs and scarves, but she wants to use other options first, and if that doesn't work, she will go with doxorubicin. Up untill now, her health was good, so a lot of people dosn't know she has cancer, and she thinks hair loss will be like wearing a sign that she has this disease.

I really hope this regimen works as at this point we feel we are running out of options.

Ruchi

[Multibilly]

Re: CyBorD when no longer responding to VRD or KRD?

by Multibilly on Sat Apr 13, 2019 10:04 am

Hi Ruchi,

My specialist still often prescribes the combination of Velcade, doxorubicin, and dex to his patients, and there are some members on this forum that have used that combination. In fact, I may use this drug combination as a front-line treatment should I progress from smoldering to symptomatic myeloma.

You may want to read this article and question the doctor about why he is suggesting a higher dose of doxorubicin every 21 days versus a lower dose administered four times over a 21 day cycle. You would also want to make sure that he is using the pegylated liposomal doxorubicin (PLD) formulation. I may be wrong, but I don't think that the other forum members suffered any hair loss when using the lower dose PLD regimen.

This article provides some insight on this subject:

Bereson, JR, et al, "A modified regimen of pegylated liposomal doxorubicin, bortezomib and dexamethasone (DVD) is effective and well tolerated for previously untreated multiple myeloma patients," British Journal of Haematology, December 2011 (full text of article)

Here is an excerpt:

"There is mounting evidence that the toxicity issues associated with regimens containing bortezomib and PLD may be improved by adjusting the doses and schedules of these agents. In our preclinical in vivo studies using our severe combined immunodeficiency‐hu myeloma models, we have shown that administration of low‐dose PLD daily markedly improved anti‐myeloma effects and was better tolerated than PLD given at a higher dose once weekly (Campbell et al, 2006). These preclinical results suggested that the more frequent administration of this anthracycline at lower doses would both improve its anti‐multiple myeloma effects as well as reduce its toxicity."

[Ron Harvot]

Re: CyBorD when no longer responding to VRD or KRD?

by Ron Harvot on Sat Apr 13, 2019 1:25 pm

Hi Ruchi,

I could not help but notice that your mom's oncologist is trying a lot of different drugs but has not used any of the newer monoclonal antibodies, such as Empliciti (elotuzumab) and Darzalex (dara­tu­mu­mab). Are these not available in India?. Those two are showing great promise in combination with Velcade or Revlimid and dex even with patients that have been refractory to both Velcade and Revlimid.

Its at least worth inquiring if those drugs are available.

[Ruchi]

Re: CyBorD when no longer responding to VRD or KRD?

by Ruchi on Sat Apr 13, 2019 4:59 pm

Thank you, Multibilly, for the information. During our next doctors visit, we will definitely ask the doctor the reason why he prefers high-dose doxorubicin vs. low dose. Also, the link that you posted, mentions 'previously untreated multiple myeloma patients'. My mother has been on various drug combinations since 2011 to keep her myeloma under control, so I hope it still works in her case.

Thanks for your response, Ron. My mother's oncologist did mention Darzalex, so I know that is available in India. Not sure about Empliciti though. But I think he wants to use Darzalex as a last resort if Kyprolis, bendamustine, and dexamethasone and then doxorubicin, pomalidomide, dexa­meth­a­sone do not work. The reason being Darzalex is expensive and her doctor doesnt have any experience with it till now.

I am not sure what other options we have after that. The doctor mentioned that after Velcade, she is not having a deep response with any of the drug combinations, and he is also not sure if used in future, melphalan will work in her case:(

Ruchi

[Ruchi]

Re: CyBorD when no longer responding to VRD or KRD?

by Ruchi on Fri Jun 14, 2019 11:24 am

Update:

After 2 cycles of Kyprolis, bendamustine (Treanda), and dexamethasone regimen (3 weeks on one week off), my mother's kappa value reduced from 2427 to 1499 mg/L, and her lambda value increased from 6.8 to 7.9, reducing her ratio from 357 to 188. However, there was an increase in her B2 microglobulin value from 9070 to 15320 ng/ml. The doctor thinks that she is responding to treatment, as the light chain ratio is more sensitive and it is reducing. We have an appointment tomorrow with the doctor, but it seems that he might continue with the current treatment regimen. Her hemoglobin is at 7.9 and serum creatinine is 1.31 mg/dL.

Ruchi