[goldmine848]

Detecting secondary cancers from Revlimid

by goldmine848 on Sat Feb 21, 2015 5:40 pm

Those of us who have chosen to use Revlimid for maintenance therapy know about studies that show an increased likelihood of developing secondary cancers. There is some disagreement over whether the risk is only for those who used melphalan as part of their induction regime, those who were exposed to melphalan in any fashion even as part of the stem cell transplant process, or if all who use Revlimid are at risk.

My question may be odd or show my naivete, but I am wondering what should those of us who are taking Revlimid be doing or paying attention to in order to detect secondary cancers as early as possible? Are there blood test results, symptoms, or scans that we should be paying closer attention to or getting?

While I imagine that our doctors are aware of this risk and so on the look out for it, I prefer to know for myself what measures are appropriate to guard against any additional risks.

[Stann]

Re: Detecting secondary cancers from Revlimid

by Stann on Sat Feb 21, 2015 5:46 pm

Great question!

I've seen a dermatologist and had a few things removed, just to err on the side of caution. And I can't help but check for lumps in my armpits and upper thighs. But I do wonder where I should be the most observant, too.

[Dr. Ken Shain]

Re: Detecting secondary cancers from Revlimid

by Dr. Ken Shain on Sun Feb 22, 2015 10:53 am

The reality of subsequent, or second, primary malignancies in the setting of (1) maintenance Revlimid post-transplant, and (2) continuing Revlimid post-melphalan-based induction therapy has been demonstrated in a number of clinical trials (Palumbo NEJM, McCarthy NEJM, and Attal NEJM; see related Beacon news article).

As most of you have heard, this 5% increase above placebo was overcome in the myeloma population at large by the significant improvement in disease control and, at least in one study, a survival advantage.

We have known for decades that HDM-ASCT [high-dose melphalan - autologous stem cell transplantation], particularly the melphalan, is associated with increased risk of marrow malignancies, specifically myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML). It is also important to note that, although there remains some debate, it looks like those are the only settings in which Revlimid is associated with second primary malignancies.

The simple answer to your question is: Age-appropriate cancer screening.

Your oncologist will check your labs and keep an eye out for multiple myeloma and for the other marrow diseases mentioned above (which would be signaled by unexplained drops in white blood cell counts, hemoglobin levels, or platelet levels).

Additional tests that will make sense include:

• Colon cancer screening
• Prostate cancer screening for men; mammograms and age-appropriate gynecological examinations for woman
• Dermatology examinations semi-annually to annually, depending on where you live and your sun exposure (we have a lot of sun in Florida).

I hope that this helps. Please let us know if you have further questions / concerns.