Hi Everyone
When I last saw my specialist, she told me after my SCT, which I have next week, I will be on maintenance for two years of Velcade, dex and thalidomide. In New Zealand, Revlimid is currently not funded and the cost is prohibitive for me, but having a dig around on the internet, have found info that indicates it is not far off being funded for people with relapsed or refractory multiple myeloma, or where peripheral neuropathy rules out the use of thalidomide.
What I'd like to know is, other than the peripheral neuropathy, what are the differences between the two drugs. I have struggled to find anything that states one drug is superior to the other in a way that makes it simple to understand. There seems to be so many variations of the disease and responses to treatment that it is very challenging reading. The Revlimid information under resources on this site is dated 2008 and I wondered if there might be more up to date information available comparing the two drugs.
Also, if treatment with thalidomide fails, is Revlimid a follow up option? I know, getting ahead of myself!
Anyway interested in your feedback
Jen
Forums
7 posts
• Page 1 of 1
-
NZMum - Name: NZMum
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: March2014
- Age at diagnosis: 49
Re: Revlimid or thalidomide?
Hi Jen,
I think that, at least in the US, most myeloma specialists feel Revlimid is more effective than thalidomide and that Revlimid also causes less serious side effects than thalidomide. I have the sense that the same opinion is probably held by many - perhaps a majority? - of myeloma specialists outside the US, but I'm less certain of that.
There is only one trial that I know of that has directly compared the two drugs, and results of that trial were made public this summer. You can read it about it in this Beacon conference report.
"ASCO 2014 Multiple Myeloma Update – Day Four: Oral Presentations," The Myeloma Beacon, June 4, 2014.
Look for the section of the article titled "MPT-T Versus MPR-R in Newly Diagnosed, Transplant-Ineligible Multiple Myeloma Patients".
This study was done in older, newly diagnosed myeloma patients, and it found that the two drugs led to similar response rates and survival times.
There was also a retrospective study done by Mayo Clinic researchers that also compared the use of Revlimid and thalidomide in newly diagnosed patients. It found that Revlimid was more effective than thalidomide.
F Gay et al., "Lenalidomide plus dexamethasone versus thalidomide plus dexamethasone in newly diagnosed multiple myeloma: a comparative analysis of 411 patients," Blood, February 18, 2010; 115 (7)
My sense from what I've read overall, and from I've seen reported by patients, is that Revlimid is definitely a better tolerated drug, and this allows it to be taken for longer periods of time and for it to be combined more easily with other drugs compared to thalidomide. I think there is also reasonable evidence that Revlimid is more effective by itself than thalidomide is by itself.
But I'm not a physician, so I would suggest you not put too much weight on my impressions.
Hope this helps a bit.
I think that, at least in the US, most myeloma specialists feel Revlimid is more effective than thalidomide and that Revlimid also causes less serious side effects than thalidomide. I have the sense that the same opinion is probably held by many - perhaps a majority? - of myeloma specialists outside the US, but I'm less certain of that.
There is only one trial that I know of that has directly compared the two drugs, and results of that trial were made public this summer. You can read it about it in this Beacon conference report.
"ASCO 2014 Multiple Myeloma Update – Day Four: Oral Presentations," The Myeloma Beacon, June 4, 2014.
Look for the section of the article titled "MPT-T Versus MPR-R in Newly Diagnosed, Transplant-Ineligible Multiple Myeloma Patients".
This study was done in older, newly diagnosed myeloma patients, and it found that the two drugs led to similar response rates and survival times.
There was also a retrospective study done by Mayo Clinic researchers that also compared the use of Revlimid and thalidomide in newly diagnosed patients. It found that Revlimid was more effective than thalidomide.
F Gay et al., "Lenalidomide plus dexamethasone versus thalidomide plus dexamethasone in newly diagnosed multiple myeloma: a comparative analysis of 411 patients," Blood, February 18, 2010; 115 (7)
My sense from what I've read overall, and from I've seen reported by patients, is that Revlimid is definitely a better tolerated drug, and this allows it to be taken for longer periods of time and for it to be combined more easily with other drugs compared to thalidomide. I think there is also reasonable evidence that Revlimid is more effective by itself than thalidomide is by itself.
But I'm not a physician, so I would suggest you not put too much weight on my impressions.
Hope this helps a bit.
Re: Revlimid or thalidomide?
I think Cheryl captured things really well. There is also the results of the FIRST trial that one can look at.
If one IMID fails (thalidomide, Revlimid, etc), doctors will often try another IMID (Revlimid, thalidomide, Pomalyst, etc) to get a response. Just because one IMID ceases to work doesn't mean another IMID won't get the job done.
So, yes, you could move to a Revlimid-inclusive drug combo if thalidomide stopped working. By that time, other IMIDs like Pomalyst may also be available in New Zealand.
You are not getting ahead of yourself by thinking through your options for your next round of treatment should the first one fail. It's a really smart thing to consider and discuss with your doc as you select your choice of drugs for front line treatment. You are going to be dealing with this disease for quite some time.
If one IMID fails (thalidomide, Revlimid, etc), doctors will often try another IMID (Revlimid, thalidomide, Pomalyst, etc) to get a response. Just because one IMID ceases to work doesn't mean another IMID won't get the job done.
So, yes, you could move to a Revlimid-inclusive drug combo if thalidomide stopped working. By that time, other IMIDs like Pomalyst may also be available in New Zealand.
You are not getting ahead of yourself by thinking through your options for your next round of treatment should the first one fail. It's a really smart thing to consider and discuss with your doc as you select your choice of drugs for front line treatment. You are going to be dealing with this disease for quite some time.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Revlimid or thalidomide?
Hi NZ Mom, I would suggest that if you have a choice of Revimid over thalidomide, the choice would clearly be Revlimid. Thalidomide does cause worse and sometimes permanent peripheral neuropathy.
In Canada, I was about to go on to thalidomide when Revlimid was approved here in 2010. With the help of the induction chemo (Velcade / dex), an auto stem cell transplant, and then low dose Revlimid, I was able to get into a CR that lasted quite a while! I was grateful afterwards that I did not need to go on thalidomide.
They are both, however, teratogenic drugs, and are tightly controlled since they could cause birth defects in women of child bearing age.
In Canada, I was about to go on to thalidomide when Revlimid was approved here in 2010. With the help of the induction chemo (Velcade / dex), an auto stem cell transplant, and then low dose Revlimid, I was able to get into a CR that lasted quite a while! I was grateful afterwards that I did not need to go on thalidomide.
They are both, however, teratogenic drugs, and are tightly controlled since they could cause birth defects in women of child bearing age.
-
Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: Revlimid or thalidomide?
Jen,
Perhaps I should have said, that once Revlimid is funded for relapsed / refractory myeloma in NZ, it would be preferable. The myeloma chemotherapy drugs tend to be very expensive, and Revlimid is no exception to that. The neuropathy caused by thalidomide can be really intense, though, and maybe your doctor would quickly switch you over once it is approved.
I did not have permanent neuropathy with Revlimid, and if I need to take more treatments, it would probably be my first option to try to control the myeloma.
Perhaps I should have said, that once Revlimid is funded for relapsed / refractory myeloma in NZ, it would be preferable. The myeloma chemotherapy drugs tend to be very expensive, and Revlimid is no exception to that. The neuropathy caused by thalidomide can be really intense, though, and maybe your doctor would quickly switch you over once it is approved.
I did not have permanent neuropathy with Revlimid, and if I need to take more treatments, it would probably be my first option to try to control the myeloma.
-
Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: Revlimid or thalidomide?
Thanks for your replies. Cheryl and Multibilly. I have read those articles and they are helpful. I have lots of questions for my specialist next week, as I have found if you don't ask, they don't tell you anything, and I have slowly worked out what to ask.
Thanks, Multibilly, one of my questions was whether Revlimid was an option after a relapse on thalidomide and I am happy to try thalidomide first. I have been lucky, Nancy, that peripheral neuropathy has been limited to 'walky legs' in the evenings and is manageable without pain relief.
Looking forward to getting some answers next week and getting on with transplant.
Jen
Thanks, Multibilly, one of my questions was whether Revlimid was an option after a relapse on thalidomide and I am happy to try thalidomide first. I have been lucky, Nancy, that peripheral neuropathy has been limited to 'walky legs' in the evenings and is manageable without pain relief.
Looking forward to getting some answers next week and getting on with transplant.
Jen
-
NZMum - Name: NZMum
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: March2014
- Age at diagnosis: 49
Re: Revlimid or thalidomide?
Hi Jen,
Revlimid is superior to thalidomide without the neuropathy. However what I want to make a point about is Velcade also causes neuropathy so if you are on Velcade and thalidomide you will be hit with overlapping neurotoxicities. That is what I would discuss with your doctor. Subcutaneous administration of Velcade is less neurotoxic than IV. Be sure to discuss this.
Hopefully the funding will come through very soon for Revlimid.
Cheers
Revlimid is superior to thalidomide without the neuropathy. However what I want to make a point about is Velcade also causes neuropathy so if you are on Velcade and thalidomide you will be hit with overlapping neurotoxicities. That is what I would discuss with your doctor. Subcutaneous administration of Velcade is less neurotoxic than IV. Be sure to discuss this.
Hopefully the funding will come through very soon for Revlimid.
Cheers
-
Anonymous
7 posts
• Page 1 of 1
Return to Treatments & Side Effects