My partner was on Velcade / dex / Revlimid for almost 2 years, his oncologist put him on Velcade / dex / poly and his numbers jumped. My partner wanted to go back to Revlimid, but was told by a myeloma specialist for whom we went to, that Revlimid would now be ineffective because he was on poly.
My partner was diagnosed with stage 4 myeloma in March 2012. He did not have a stem cell transplant, and he never reached a real remission.
I would like to know what other people know or have heard about Revlimid being ineffective after treatment with poly or other chemo drugs.
Thanks,
CAndyce
Forums
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Candyce - Name: Candyce
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: March 2012
- Age at diagnosis: 69
Re: Does Revlimid become ineffective?
Hi Candyce,
Just to clarify things a bit, which medication do you mean when you say "poly"? Do you mean Pomalyst (pomalidomide)?
Just to clarify things a bit, which medication do you mean when you say "poly"? Do you mean Pomalyst (pomalidomide)?
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Jonah
Re: Does Revlimid become ineffective?
My multiple myeloma friend is on year 7 of all of this and has been through everything.
Now they are going back and combining the different therapies that had started to fail him, and he's getting great results.
Now they are going back and combining the different therapies that had started to fail him, and he's getting great results.
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stann
Re: Does Revlimid become ineffective?
Yes, Pomalyst (pomalidomide). I'm trying to find out if Revlimid becomes ineffective after a treatment of Pomalyst. He was treated with Velcade, dex, and Revlimid for about 2 years, then Velcade, dex, and Pomalyst for three months, and his numbers jumped.
Looking to hear from you and others about your experience.
Thanks,
Candyce
Looking to hear from you and others about your experience.
Thanks,
Candyce
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Candyce - Name: Candyce
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: March 2012
- Age at diagnosis: 69
Re: Does Revlimid become ineffective?
Revlimid and Pomalyst are in the same family of drugs and even made by the same drug company, Celgene. They are known as immunomodulatory drugs, or "IMiDs."
Since they work in the same manner, it is very possible that if a patient is refractory to Pomalyst, they will also be refractory to Revlimid. However, that is not always the case. The oldest of the IMiDs, thalidomide, sometimes works when Revlimid no longer does. Although these drugs are related and work in a similar way, they are not identical. Thus, it is still possible that one may work when the other does not.
The same is true with the proteasome inhibitors, such as Velcade and Krypolis. When one fails, the other may still work.
Good luck,
Ron
Since they work in the same manner, it is very possible that if a patient is refractory to Pomalyst, they will also be refractory to Revlimid. However, that is not always the case. The oldest of the IMiDs, thalidomide, sometimes works when Revlimid no longer does. Although these drugs are related and work in a similar way, they are not identical. Thus, it is still possible that one may work when the other does not.
The same is true with the proteasome inhibitors, such as Velcade and Krypolis. When one fails, the other may still work.
Good luck,
Ron
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Ron Harvot - Name: Ron Harvot
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Feb 2009
- Age at diagnosis: 56
Re: Does Revlimid become ineffective?
The area of "retreatment" with the same class of drugs at a later time is a developing field.
There have indeed been studies such as the one below which analyzes if one can go back an re-treat with the exact same drug or another member of that drug family. This is one study that looks at retreating patients that have either been on thalidomide (also in the IMiD family with Revlimid and Pomalyst) or Revlimid, and then retreating those patients with one or the other drug.
"Nineteen (58%) of the 33 patients who had a PR or better to initial lenalidomide therapy obtained a PR or better with repeat use of lenalidomide".
It has also been shown that folks who started with Velcade can also benefit from Velcade again if they become R/R.
And as Stann mentioned, recombining "your old friends" with other drugs can often times yield quite good results.
So, I might suggest exploring this topic a bit more with your specialist and / or getting a second opinion on the matter. Of course, I'm not a doc and I am also not speaking out of any personal experience here.
S Madan et al, "Efficacy of retreatment with immunomodulatory drugs (IMiDs) in patients receiving IMiDs for initial therapy of newly diagnosed multiple myeloma," Blood, Aug 18, 2011 (full text)
Abstract:
The efficacy of retreatment with immunomodulatory drugs (IMiDs) among patients with multiple myeloma who received this class of drugs for initial therapy is unknown. We studied 140 patients who received either thalidomide-dexamethasone (81; 58%) or lenalidomide-dexamethasone (59; 42%) as first-line therapy of multiple myeloma followed by repeat IMiD (thalidomide [34; 24%] or lenalidomide [106; 76%]) as one of the salvage regimens. A median of 2 treatments (range, 1-6), including a stem cell transplant in 105 patients (75%), were administered before IMiD-based salvage therapy. The median time from diagnosis to repeat exposure to IMiD was 28 months. Among the 113 evaluable patients, 50 (44%) achieved at least a partial response, and 63 (56%) achieved less than a partial response to repeat IMiD. Response rates with lenalidomide retreatment were higher than with repeat administration of thalidomide.
There have indeed been studies such as the one below which analyzes if one can go back an re-treat with the exact same drug or another member of that drug family. This is one study that looks at retreating patients that have either been on thalidomide (also in the IMiD family with Revlimid and Pomalyst) or Revlimid, and then retreating those patients with one or the other drug.
"Nineteen (58%) of the 33 patients who had a PR or better to initial lenalidomide therapy obtained a PR or better with repeat use of lenalidomide".
It has also been shown that folks who started with Velcade can also benefit from Velcade again if they become R/R.
And as Stann mentioned, recombining "your old friends" with other drugs can often times yield quite good results.
So, I might suggest exploring this topic a bit more with your specialist and / or getting a second opinion on the matter. Of course, I'm not a doc and I am also not speaking out of any personal experience here.
S Madan et al, "Efficacy of retreatment with immunomodulatory drugs (IMiDs) in patients receiving IMiDs for initial therapy of newly diagnosed multiple myeloma," Blood, Aug 18, 2011 (full text)
Abstract:
The efficacy of retreatment with immunomodulatory drugs (IMiDs) among patients with multiple myeloma who received this class of drugs for initial therapy is unknown. We studied 140 patients who received either thalidomide-dexamethasone (81; 58%) or lenalidomide-dexamethasone (59; 42%) as first-line therapy of multiple myeloma followed by repeat IMiD (thalidomide [34; 24%] or lenalidomide [106; 76%]) as one of the salvage regimens. A median of 2 treatments (range, 1-6), including a stem cell transplant in 105 patients (75%), were administered before IMiD-based salvage therapy. The median time from diagnosis to repeat exposure to IMiD was 28 months. Among the 113 evaluable patients, 50 (44%) achieved at least a partial response, and 63 (56%) achieved less than a partial response to repeat IMiD. Response rates with lenalidomide retreatment were higher than with repeat administration of thalidomide.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Does Revlimid become ineffective?
So why not stop maintenance Revlimid after two years and restart upon disease progression?
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coachhoke - Name: coachhoke
- When were you/they diagnosed?: Apri 2012
- Age at diagnosis: 71
Re: Does Revlimid become ineffective?
CAndyce,
What exactly was the sequence of events between when your husband was on RVD (Revlimid, Velcade, dex) when he was put on PVD (Pomalyst, Velcade, dex)?
Did your husband stop responding to RVD, and is that why he was put on PVD?
Also, how long was the time between when he was on RVD and PVD?
I think the answers to these questions matter before we all assume that CAndyce's husband might still respond to RVD. If, for example, he was put on PVD soon after he had been on RVD because he stopped responding to RVD, then he will have failed treatment with two regimens containing two different imids administered soon after one another. Not only that, his second failure was in the form of rapidly climbing numbers.
If all that was true, I don't think it's unreasonable for a doctor to think that Revlimid probably won't be very effective. In addition, the doctor probably wants to use something that has a high chance of getting the disease under control quickly, given how rapidly CAndyce's husband's numbers were climbing.
Retreatment with the same drug, or drugs in the same class, is all well and fine in theory, and it's worth making sure people are aware of the option. But it's not always going to be the best option in actual practice.
What exactly was the sequence of events between when your husband was on RVD (Revlimid, Velcade, dex) when he was put on PVD (Pomalyst, Velcade, dex)?
Did your husband stop responding to RVD, and is that why he was put on PVD?
Also, how long was the time between when he was on RVD and PVD?
I think the answers to these questions matter before we all assume that CAndyce's husband might still respond to RVD. If, for example, he was put on PVD soon after he had been on RVD because he stopped responding to RVD, then he will have failed treatment with two regimens containing two different imids administered soon after one another. Not only that, his second failure was in the form of rapidly climbing numbers.
If all that was true, I don't think it's unreasonable for a doctor to think that Revlimid probably won't be very effective. In addition, the doctor probably wants to use something that has a high chance of getting the disease under control quickly, given how rapidly CAndyce's husband's numbers were climbing.
Retreatment with the same drug, or drugs in the same class, is all well and fine in theory, and it's worth making sure people are aware of the option. But it's not always going to be the best option in actual practice.
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JimNY
Re: Does Revlimid become ineffective?
As always, all good points Jim. What you say makes a lot of sense to me.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Does Revlimid become ineffective?
Thanks, Multibilly. And, as I said, I think you and the others who have raised the possibility of retreatment are making a valid point, and it's good to make sure people are aware of that option.
One other thing to keep in mind in this specific case is that the doctor may not be giving up completely on Revlimid. He/she may be thinking that it doesn't have a good chance of working now, but might consider trying it again after one or two other therapies that don't involve Revlimid (or another imid).
One other thing to keep in mind in this specific case is that the doctor may not be giving up completely on Revlimid. He/she may be thinking that it doesn't have a good chance of working now, but might consider trying it again after one or two other therapies that don't involve Revlimid (or another imid).
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JimNY
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