[Stann]

Rotating maintenance therapies

by Stann on Sat Dec 01, 2012 2:00 pm

With more tools in the chemical therapy tool shed, is there research or treatment where maintenance is achieved by rotating several different chemicals, one at a time?
For example, after reducing multiple myeloma load to low levels or remission, patient takes Revlimid for 3 months, Carfilzomeb for 3 months, Thalidomide for a month, Velcade for 3 months, 3 months off, 3 months Revlimid etc, etc.
It seems the myeloma cells would be under attack from multiple directions at all times, but the non target cells would only suffer for only 3 months at a time. I would think it would slow down (eliminate??) resistance building up to one therapy.
Is this already being done and I'm just using the wrong terminology?
Thanks, Stann

[mrsv118]

Re: Rotating maintenance therapies

by mrsv118 on Sat Dec 01, 2012 7:47 pm

Love your thought process, Stann. Looking forward to what the Beacon staff have to say.

Kate

[Stann]

Re: Rotating maintenance therapies

by Stann on Mon Dec 03, 2012 11:36 am

Thanks Kate!
Maybe my question could be boiled down a little better.
I have been on maintenance Revlimid for over a year now. My numbers are good. But rather than wait for it to stop working, why not rotate to carfilzomeb for 2 months, then back to Revlimid?
Just in case there are a few cells that are starting to develop resistance to the action of Revlimid, why not hit them with something else so that when you start back on maintenance Revlimid, you have reset the "resistance clock" to zero. It would be a proactive approach/preemptive strike.
It is how farmers prevent resistance from building up to certain materials, especially with fungicides. Chemical companies work together and have developed protocols so that growers do not use the same materials twice in the same year. (it makes financial sense to them too).
In this case, Celgene could conceivably have a patient for 20-30 years rather than 5 years.

[suzierose]

Re: Rotating maintenance therapies

by suzierose on Mon Dec 03, 2012 2:50 pm

Hi Stann,

I agree with your therapeutic rationale.

[Nancy Shamanna]

Re: Rotating maintenance therapies

by Nancy Shamanna on Mon Dec 03, 2012 3:04 pm

I think that it is an interesting idea to rotate different drugs for maintenance therapy, but I am also glad not to be on any maintenance now. I would wait until I relapsed, and if that happened see what my doctors recommended. Whether or not it would be different from any drug I had had previously might be more due to if I had shown resistance to a previous drug....also availability! If you have taken a course of maintenance, it worked, and you are not taking myeloma drugs now, why couldn't you just go back to what worked before?

[stann]

Re: Rotating maintenance therapies

by stann on Mon Dec 03, 2012 5:10 pm

Hi Nancy,
"If you have taken a course of maintenance, it worked, and you are not taking myeloma drugs now, why couldn't you just go back to what worked before?"
My point was for those on long term maintenance. But even with shorter term maintenance, some patients develop resistance to Revlimid, so maybe rotating after 6 months might have prevented resistance "strains" of multiple myeloma to Revlimid?

This is basic resistance management for pests, (weeds, insects, fungus etc), I don't know why it wouldn't work for myeloma.

[Nancy Shamanna]

Re: Rotating maintenance therapies

by Nancy Shamanna on Mon Dec 03, 2012 5:26 pm

Sounds like a subject for a clinical trial, doesn't it? I did actually take a whole year of low dose Revlimid, which seemed like quite a long time to me! Of course I realize that many patients develop reactions or resistances to drugs and they need to try different approaches. Maybe one way of working out your idea would be to sequentially take drugs, instead of having them in a combination? Just guessing here...but I guess like anything else it would need further study.