[ksushagal]

If Velcade does not work as a first-line therapy

by ksushagal on Thu Jul 26, 2012 9:12 am

My father is 51, and he was diagnosed 2,5 months ago, on 05/05/2012. He has IgG multiple myeloma, stage 2a, 50% of myeloma cells (although earlier his doctors said it was non secretory multiple myeloma, since they were not able to find anything in his blood and urine).

He started his treatment (bortezomib + Cyclophosphamide + Dexamethasone) in May, and he was expected to have 4 courses of chemo and an autologous stem cell transplant, but after the 3rd course (in the middle of July) he had high temperature (37.5–38.5 C, or 99,5–101,3 F), and the biopsy showed that the percent of myeloma cells is still the same, namely 50%.

Now the doctors are looking for some other treatment, so I was wondering if any of you have had the same problem, what was the solution and what happened next.

We live in Russia, where carfilzomib, for example, will hardly be available soon, but do you think it is the best or the only option in our case?

Thanks in advance.

P.S. If you need more information or test results, I will be happy to provide them.

[Rajat]

Re: If Velcade does not work as a first-line therapy

by Rajat on Tue Dec 10, 2013 12:20 pm

My father was diagnosed with multiple myeloma this year and he is facing a similar issue. Currently, he is taking lenalidomide/dexamethasone. Is there any other alternative?

[ksushagal]

Re: If Velcade does not work as a first-line therapy

by ksushagal on Tue Dec 10, 2013 12:44 pm

Dear Rajat, unfortunately, I have no idea about what might help.

I think, our doctors also used Cisplatin, which did help a little, but also caused terrible side effects.

All the best to you and your father.

[Multibilly]

Re: If Velcade does not work as a first-line therapy

by Multibilly on Tue Dec 10, 2013 3:40 pm

I can't speak to what may be available in Russia, but there are indeed alternatives. As mentioned before, Revlimid with Dex is one. Others that you can consider that don't include newer agents like Pomalyst or Kyprolis are:

TRIPLETS
Velcade+Revlimid + Dex
Velcade + Doxil + Dex
Velcade + Thalidomide + Dex

DOUBLETS
Velcade + Dex
Revlimid + Dex
Thalidomide + Dex

I'm not qualified to suggest one of these over another in your Dad's situation, but Velcade/Revlimid/Dex and Velcade/Doxil/Dex are two of the combinations that a couple of my docs might suggest if I progress to symptomatic multiple myeloma. Quite a few professionals are leaning more heavily towards the use of a triplet cocktail over a doublet here in the USA.

But you also need to be careful about not using up all your bullets up front and to take a longer term look at what you would do next if you should become refractory (resistant) to one of these combinations down the line...especially if Pomalyst or Kyrpolis or a trial with a new drug isn't an option for you in your country.