Hi,
My mother, who was diagnosed with multiple myeloma a few years ago, has already been treated with Velcade and Revlimid.
Now when the Revlimid impact is declining, her doctor suggested her to start a new trial treatment with injections of Darzalex.
In case the treatment with Darzalex (4th line drug) fails or has no impact, can she still be treated with Kyprolis (3rd line drug)?
Thanks,
Liran.
Forums
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liranraz - Name: liranraz
- Who do you know with myeloma?: mother
- When were you/they diagnosed?: Israel
- Age at diagnosis: 67
Re: Kyprolis treatment after Darzalex treatment?
Hi liranraz,
I do not think there is any reason from a medical perspective why your mother could not be treated with Kyprolis after having received treatment with Darzalex.
In fact, medically speaking, there are not many restrictions on when treatments can be given to myeloma patients. Velcade, for example, can be used to treat newly diagnosed patients. However, it also could be used to treat patients who already have undergone several other treatments, including Velcade itself.
You should check, though, whether there are any insurance restrictions that might prevent your mother from being treated with Kyprolis after she's received Darzalex. I doubt there would be any such restrictions, but it's worth checking, just to make sure.
Good luck!
I do not think there is any reason from a medical perspective why your mother could not be treated with Kyprolis after having received treatment with Darzalex.
In fact, medically speaking, there are not many restrictions on when treatments can be given to myeloma patients. Velcade, for example, can be used to treat newly diagnosed patients. However, it also could be used to treat patients who already have undergone several other treatments, including Velcade itself.
You should check, though, whether there are any insurance restrictions that might prevent your mother from being treated with Kyprolis after she's received Darzalex. I doubt there would be any such restrictions, but it's worth checking, just to make sure.
Good luck!
Re: Kyprolis treatment after Darzalex treatment?
As Cheryl G indicated, check to make sure your insurance will cover it, but otherwise I don't think it would be an issue receiving Kyprolis after Darzalex.
I started with Kyprolis for two years, was on maintenance with Revlimid for about three years, then was on Empliciti (elotuzumab) for almost two years, and now I just started taking Ninlaro (ixazomib).
Kyprolis and Ninlaro are both proteasome inhibitors, whereas Darzalex and Empliciti are both monoclonal antibodies. So while I haven't taken exactly the same drugs in sequence as you mention, it is very similar. Yours is proteasome inhibitor -> monoclonal antibody, mine has been monoclonal antibody -> proteasome inhibitor -> monoclonal antibody.
One thing my doctor has mentioned is that research suggests it may not be good to follow one category of drug with a drug in the same category. For example, you probably wouldn't want to follow Kyprolis with Ninlaro since they are both proteasome inhibitors, or follow Darzalex with Empliciti since they are both monoclonal antibodies.
Good luck.
I started with Kyprolis for two years, was on maintenance with Revlimid for about three years, then was on Empliciti (elotuzumab) for almost two years, and now I just started taking Ninlaro (ixazomib).
Kyprolis and Ninlaro are both proteasome inhibitors, whereas Darzalex and Empliciti are both monoclonal antibodies. So while I haven't taken exactly the same drugs in sequence as you mention, it is very similar. Yours is proteasome inhibitor -> monoclonal antibody, mine has been monoclonal antibody -> proteasome inhibitor -> monoclonal antibody.
One thing my doctor has mentioned is that research suggests it may not be good to follow one category of drug with a drug in the same category. For example, you probably wouldn't want to follow Kyprolis with Ninlaro since they are both proteasome inhibitors, or follow Darzalex with Empliciti since they are both monoclonal antibodies.
Good luck.
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Kevin J - Name: Kevin J
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: Jan 2011
- Age at diagnosis: 52
Re: Kyprolis treatment after Darzalex treatment?
I've been on Kyprolis for 14 months. Two months ago my oncologist added Darzalex with the Kyprolis for treatment. She will be removing me from the Kyprolis in a month and continue the Darzalex.
Be aware that Darzalex is not a shot; it's an intravenous infusion. My Darzalex currently takes approximately 5 hours to be administered as it has to be given slowly. Consider getting a port. Side effects of the Darzalex for me were minimal.
Be aware that Darzalex is not a shot; it's an intravenous infusion. My Darzalex currently takes approximately 5 hours to be administered as it has to be given slowly. Consider getting a port. Side effects of the Darzalex for me were minimal.
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coop223 - Name: derek cooper
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: November 2011
- Age at diagnosis: 57
Re: Kyprolis treatment after Darzalex treatment?
I just completed my first cycle of 6 Kyprolis infusions and my lambda light chain number was reduced by more than half after only four infusions. I was treated with Darzalex for one year when it stopped working. It did however keep me stable without major side effects. Darzalex may be reintroduced for my treatment at a later date.
Re: Kyprolis treatment after Darzalex treatment?
Thanks all for your replies. The Darzalex, which my mother has been getting for the last 7 weeks
in subcutaneous, has not been having the expected response, so she might need to replace it
with another drug soon (or combination of drugs). The replies will be helpful for us when we'll need to decide which drug we'd like to continue with.
Liran
in subcutaneous, has not been having the expected response, so she might need to replace it
with another drug soon (or combination of drugs). The replies will be helpful for us when we'll need to decide which drug we'd like to continue with.
Liran
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liranraz - Name: liranraz
- Who do you know with myeloma?: mother
- When were you/they diagnosed?: Israel
- Age at diagnosis: 67
Re: Kyprolis treatment after Darzalex treatment?
Kevin J wrote;
Hi Kevin J,
Can you clarify what research “suggests that it may not be good to follow one category of drug with a drug in the same category”?
My understanding is that it is a common practice to do just that. And for many good reasons. For example, I started on Velcade (bortezomib) which was not effective in my case. This was followed by Kyprolis (carfilzomib) which was extremely effective but recently had to be discontinued due to cardiotoxic effects. I have just started on Ninlaro (ixazomib) which apparently does not have the adverse heart side effects that characterize Kyprolis.
All of these drugs are proteasome inhibitors, but are not identical either in composition, mechanism of action, nor side effects. Why wouldn’t one switch to another proteasome inhibitor based on effectiveness and/or side effects? There are subcategories of proteasome inhibitors; perhaps that is what the research you cited was referring to?
I’d be very interested in knowing what research you are referring to. Thanks.
One thing my doctor has mentioned is that research suggests it may not be good to follow one category of drug with a drug in the same category. For example, you probably wouldn't want to follow Kyprolis with Ninlaro since they are both proteasome inhibitors, or follow Darzalex with Empliciti since they are both monoclonal antibodies.
Hi Kevin J,
Can you clarify what research “suggests that it may not be good to follow one category of drug with a drug in the same category”?
My understanding is that it is a common practice to do just that. And for many good reasons. For example, I started on Velcade (bortezomib) which was not effective in my case. This was followed by Kyprolis (carfilzomib) which was extremely effective but recently had to be discontinued due to cardiotoxic effects. I have just started on Ninlaro (ixazomib) which apparently does not have the adverse heart side effects that characterize Kyprolis.
All of these drugs are proteasome inhibitors, but are not identical either in composition, mechanism of action, nor side effects. Why wouldn’t one switch to another proteasome inhibitor based on effectiveness and/or side effects? There are subcategories of proteasome inhibitors; perhaps that is what the research you cited was referring to?
I’d be very interested in knowing what research you are referring to. Thanks.
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MrPotatohead - Name: MrPotatohead
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: March, 2015
- Age at diagnosis: 65
Re: Kyprolis treatment after Darzalex treatment?
MrPotatohead,
'Research' in this context was used in a more general sense. I don't know if there is a specific study looking into whether switching categories vs. remaining with a similar drug has a benefit.
The topic came up while my doctor and I were discussing options for my current treatment and I interpreted his statement that he, and perhaps some of his colleagues, have been looking at the results of treatments and are seeing evidence or patterns that may suggest switching categories of drugs may provide better response.
As he and I discussed it, the hypothesis appears to be that the cancer cells may acclimate to a particular category of drug and therefore make it more likely to resist another drug in the same category. Switching to a new category would disrupt its defenses and therefore make it less likely to resist the different drug.
I likened it somewhat to the principle of changing my exercise routines on a regular basis to introduce disruption so my body doesn't get use to the same repetitive workout. I find I respond much better when I do this than if I stay with the same workout for extended periods.
I have my next appointment this week and will ask him if there is specific research into this.
'Research' in this context was used in a more general sense. I don't know if there is a specific study looking into whether switching categories vs. remaining with a similar drug has a benefit.
The topic came up while my doctor and I were discussing options for my current treatment and I interpreted his statement that he, and perhaps some of his colleagues, have been looking at the results of treatments and are seeing evidence or patterns that may suggest switching categories of drugs may provide better response.
As he and I discussed it, the hypothesis appears to be that the cancer cells may acclimate to a particular category of drug and therefore make it more likely to resist another drug in the same category. Switching to a new category would disrupt its defenses and therefore make it less likely to resist the different drug.
I likened it somewhat to the principle of changing my exercise routines on a regular basis to introduce disruption so my body doesn't get use to the same repetitive workout. I find I respond much better when I do this than if I stay with the same workout for extended periods.
I have my next appointment this week and will ask him if there is specific research into this.
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Kevin J - Name: Kevin J
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: Jan 2011
- Age at diagnosis: 52
Re: Kyprolis treatment after Darzalex treatment?
Kevin,
I would also be interested in what your doctor says. It makes sense and I like your exercise analogy. I have been on Velcade for over 9 years but it is no longer as effective. I have a lot of options including the route you went with Empliciti or going with Kyprolis. We are trying to milk out as much as we can from Velcade before changing.
I would also be interested in what your doctor says. It makes sense and I like your exercise analogy. I have been on Velcade for over 9 years but it is no longer as effective. I have a lot of options including the route you went with Empliciti or going with Kyprolis. We are trying to milk out as much as we can from Velcade before changing.
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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: Kyprolis treatment after Darzalex treatment?
Kevin and Ron,
So I understand the theory and it may be true. But I have also seen it hypothesized that we all have several to many myeloma types. The first treatments that we receive kill certain types and the use of triplets or quadruplets increases the breadth of the killing force. But once those treatments have killed off the types of cells susceptible to those treatments, it gives the remaining types room to grow. Since those types may not respond the earlier treatments new ones are necessary.
This is why the goal of being able to identify the types of myeloma cells a particular patient has and matching that patient with the treatments most likely to kill those types of myeloma cells is so important.
So I understand the theory and it may be true. But I have also seen it hypothesized that we all have several to many myeloma types. The first treatments that we receive kill certain types and the use of triplets or quadruplets increases the breadth of the killing force. But once those treatments have killed off the types of cells susceptible to those treatments, it gives the remaining types room to grow. Since those types may not respond the earlier treatments new ones are necessary.
This is why the goal of being able to identify the types of myeloma cells a particular patient has and matching that patient with the treatments most likely to kill those types of myeloma cells is so important.
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goldmine848 - Name: Andrew
- When were you/they diagnosed?: June 2013
- Age at diagnosis: 60
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