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Anyone use melphalan with Velcade?
My mother's insurance will not approve Doxil (doxorubicin liposomal) as part of her initial treatment regimen, and I'm looking for other options if the appeal doesn't go through.
Re: Anyone use melphalan with Velcade?
kljr1022,
I have not heard of Doxil being used to treat myeloma, so why are you trying to get it approved for your mom?
Also, both Doxil and melphalan have horrid side effect profiles. Why is she not going on a more standard protocol, like Revlimid, Velcade, and dex? Yes, they also have side effects, but noting akin to Doxil and melphalan, and their efficacy for treating myeloma is well established.
Aloha, Daniel
I have not heard of Doxil being used to treat myeloma, so why are you trying to get it approved for your mom?
Also, both Doxil and melphalan have horrid side effect profiles. Why is she not going on a more standard protocol, like Revlimid, Velcade, and dex? Yes, they also have side effects, but noting akin to Doxil and melphalan, and their efficacy for treating myeloma is well established.
Aloha, Daniel
-
DanielR - Name: Daniel Riebow
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: 12/2012
- Age at diagnosis: 59
Re: Anyone use melphalan with Velcade?
Hi kljr1022,
Sorry to hear about the insurance problems that your mother is having.
Doxil is FDA-approved as a myeloma treatment, but its approval is for use in relapsed myeloma patients. It's been tested in newly diagnosed myeloma patients, and some myeloma specialists will use it in newly diagnosed patients, often in combination with Velcade, but it's not regularly used for that purpose. That may be why the insurance company is pushing back.
If your mother is being seen by a myeloma specialist, however, I wouldn't be surprised if he / she is able to put together the paperwork to get the treatment with Doxil approved on appeal.
If that doesn't work out, combining Velcade with melphalan and prednisone (VMP) is something that has been common in Europe in newly diagnosed myeloma patients, but not so much in the U.S., where Velcade-Cytoxan-dex (VCD, CyBorD) and Velcade-Revlimid-dex (VRD, RVD) are the most common three-drug regimens for newly diagnosed myeloma.
How old is your mom and what sort of health is she in? If she is older and somewhat frail, melphalan may not be the best choice. Still, if your mother is working with a myeloma specialist, and he or she is considering melphalan, there are probably reasons for the strategy. For example, the doctor may want to save Cytoxan and Revlimid to use later in your mother's treatment, after a first or second relapse.
In any case, if you want to read about the sort of side effects that come up with Velcade, melphalan, and prednisone treatment, check out the official Velcade prescribing information approved by the FDA:
http://www.accessdata.fda.gov/drugsatfda_docs/label/2014/021602s040lbl.pdf
See, in particular, Table 9 on page 12 for a list of common serious side effects patients experienced with the treatment.
And, in case you're interested, here is the prescribing information for Doxil, which has information on its side effects when used together with Velcade to treat relapsed myeloma patients:
http://www.accessdata.fda.gov/drugsatfda_docs/label/2013/050718s045lbl.pdf
Good luck!
Sorry to hear about the insurance problems that your mother is having.
Doxil is FDA-approved as a myeloma treatment, but its approval is for use in relapsed myeloma patients. It's been tested in newly diagnosed myeloma patients, and some myeloma specialists will use it in newly diagnosed patients, often in combination with Velcade, but it's not regularly used for that purpose. That may be why the insurance company is pushing back.
If your mother is being seen by a myeloma specialist, however, I wouldn't be surprised if he / she is able to put together the paperwork to get the treatment with Doxil approved on appeal.
If that doesn't work out, combining Velcade with melphalan and prednisone (VMP) is something that has been common in Europe in newly diagnosed myeloma patients, but not so much in the U.S., where Velcade-Cytoxan-dex (VCD, CyBorD) and Velcade-Revlimid-dex (VRD, RVD) are the most common three-drug regimens for newly diagnosed myeloma.
How old is your mom and what sort of health is she in? If she is older and somewhat frail, melphalan may not be the best choice. Still, if your mother is working with a myeloma specialist, and he or she is considering melphalan, there are probably reasons for the strategy. For example, the doctor may want to save Cytoxan and Revlimid to use later in your mother's treatment, after a first or second relapse.
In any case, if you want to read about the sort of side effects that come up with Velcade, melphalan, and prednisone treatment, check out the official Velcade prescribing information approved by the FDA:
http://www.accessdata.fda.gov/drugsatfda_docs/label/2014/021602s040lbl.pdf
See, in particular, Table 9 on page 12 for a list of common serious side effects patients experienced with the treatment.
And, in case you're interested, here is the prescribing information for Doxil, which has information on its side effects when used together with Velcade to treat relapsed myeloma patients:
http://www.accessdata.fda.gov/drugsatfda_docs/label/2013/050718s045lbl.pdf
Good luck!
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