[rechevar]

Not responding to Kyprolis, looking for alternatives

by rechevar on Mon Aug 17, 2015 7:54 pm

After having a solitary plasmacytoma last summer, my husband was diagnosed with full-blown multiple myeloma in November after a spontaneous break of his clavicle. He started on Revlimid / dex, but developed a deep vein thrombosis (DVT) even though he was already on warfarin (Coumadin), so he was switched to Kyprolis.

He has completed 5 cycles, and his lambda light chains are increasing. His M protein has never been particularly high. His doc says his case is unusual and hard to track. His doc is considering switching him to Pomalyst, but I am concerned as it is reported to have serious to life-threatening interactions with just about every other drug he is on. Additionally, it seems so many of the multiple myeloma drugs need to be taken with Decadron, which was NOT a good fit for him.

I am pretty depressed right now. Is this how it is? Just chase drug after drug? He is ineligible for SCT due to his age (81), but a very YOUNG 81!

Does anyone have any suggestions? We have Kaiser insurance, and I am thinking very strongly of switching to something else in the fall that has a plan which specializes in multiple myeloma.

[Little Monkey]

Re: Not responding to Kyprolis, looking for alternatives

by Little Monkey on Mon Aug 17, 2015 9:13 pm

Have you spoken to the doctor about switching out the dex (Decadron) for prednisone?

[Tough Mom]

Re: Not responding to Kyprolis, looking for alternatives

by Tough Mom on Fri Aug 21, 2015 6:54 pm

Some alternatives to discuss would be to combine the Pomalyst with the current Kyrpolis. Pomalyst can be given at 2 mg rather than 4 mg and is still very efficacious. The lower dose would reduce the chances of interaction. Pomalyst really does work markedly better with dexa­meth­a­sone, though, so I think you are right to not be too excited about trying it as a single agent. It has the same risk of coagulation disorders that Revlimid does, as it is the same class of drug.

You might want to look into and discuss a melphalan prednisone (MP) regimen, or an oral cyclophosphamide regimen. We (and the doctors) get excited to recommend and use the "new" drugs, but it is important not to forget the basic drugs that have been used for many years very successfully. MP has still been the standard regimen in Europe for many years, and has very strong data in elderly transplant ineligible patients.

As everyone on this forum strongly recommends, please get a second opinion from a myeloma specialist (someone who ONLY treats myeloma) if you are not seeing one already.