Thought those that those dealing with a relapse/refractory situation might find this article to be useful:
http://journals.lww.com/oncology-times/blog/onlinefirst/pages/post.aspx?PostID=1000
Some options that are mentioned:
- Increase doses of existing treatment(s)
- Try antibiotics like Biaxin (clarithromycin)
- Try drugs the patient hasn't had before
- Try drugs together the patient has had separately
- Try drugs the patient had before, but a while ago
- Don't assume kidney issues are myeloma-related (could be due to anemia or diabetes)
Forums
6 posts
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Treatment options for relapsed myeloma (Berenson)
Thanks Multibilly!
I've bookmarked this and will refer to it when my Pomalyst / dex / Kyprolis isn't effective. As always, you are very helpful!
I wonder why the antibiotic would be effective?
I've bookmarked this and will refer to it when my Pomalyst / dex / Kyprolis isn't effective. As always, you are very helpful!
I wonder why the antibiotic would be effective?
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Joy - Name: Joy
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: May 2013
- Age at diagnosis: 52
Re: Treatment options for relapsed myeloma (Berenson)
Good question Joy.
See: http://bloodjournal.hematologylibrary.org/content/111/3/1101.full
"... Clarithromycin appears to optimize the pharmacologic effect of glucocorticoids by increasing the area under the curve and the maximum concentration levels of certain corticosteroids. Clarithromycin has immunomodulatory properties, partially mediated by the suppression of interleukin-6 and other inflammatory cytokines. There may also be a direct antineoplastic effect mediated by clarithromycin..."
See: http://bloodjournal.hematologylibrary.org/content/111/3/1101.full
"... Clarithromycin appears to optimize the pharmacologic effect of glucocorticoids by increasing the area under the curve and the maximum concentration levels of certain corticosteroids. Clarithromycin has immunomodulatory properties, partially mediated by the suppression of interleukin-6 and other inflammatory cytokines. There may also be a direct antineoplastic effect mediated by clarithromycin..."
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Treatment options for relapsed myeloma (Berenson)
In the article linked to by Multibilly, we read
I would advise him to be more tactful. Many of us have been conflicted between going ahead with the trying experience or not. More than one hematologist told me that it is possible that, with the new drugs, it can be avoided, but as the data are too new, it is safer to follow the traditional path.
For me the transplant has been horrendous: frequent vomit and diarrhea for many days, fever, rapid loss of weight, and a bad stomach ache lasting months. Add the loss of hair and the fear about the effects of melphalan, and "I do not do transplants anymore" does not sound too appropriate
After his talk, Berenson was asked from the audience about transplants. “The era of transplants is over,” he replied. “I do not do transplants anymore."
I would advise him to be more tactful. Many of us have been conflicted between going ahead with the trying experience or not. More than one hematologist told me that it is possible that, with the new drugs, it can be avoided, but as the data are too new, it is safer to follow the traditional path.
For me the transplant has been horrendous: frequent vomit and diarrhea for many days, fever, rapid loss of weight, and a bad stomach ache lasting months. Add the loss of hair and the fear about the effects of melphalan, and "I do not do transplants anymore" does not sound too appropriate
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Annamaria - Name: Annamaria
- Who do you know with myeloma?: I am a patient
- When were you/they diagnosed?: April 2012
- Age at diagnosis: 58
Re: Treatment options for relapsed myeloma (Berenson)
Interesting, especially the reference to stem cell transplants.
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Wayne K - Name: Wayne
- Who do you know with myeloma?: Myself, my sister who passed in '95
- When were you/they diagnosed?: 03/09
- Age at diagnosis: 70
Re: Treatment options for relapsed myeloma (Berenson)
The subject of transplants wasn't the reason I posted that URL.
There really are some good gems in Dr. Berenson's treatment summary, should somebody become R/R. There is also a message in there that just because some drug has been around for decades doesn't mean that it shouldn't be considered for treatment, especially in a R/R setting.
I often fall into the trap that the best treatment has got to be something cutting-edge like a next-generation monoclonal antibody or T-cell immunotherapy. But in reality, it may be something like Treanda or thalidomide (or just a tweaking of a dose or reintroducing a previously used drug) that will be the saving grace for a given patient ... even in the USA, where we are blessed with so many drug options.
There really are some good gems in Dr. Berenson's treatment summary, should somebody become R/R. There is also a message in there that just because some drug has been around for decades doesn't mean that it shouldn't be considered for treatment, especially in a R/R setting.
I often fall into the trap that the best treatment has got to be something cutting-edge like a next-generation monoclonal antibody or T-cell immunotherapy. But in reality, it may be something like Treanda or thalidomide (or just a tweaking of a dose or reintroducing a previously used drug) that will be the saving grace for a given patient ... even in the USA, where we are blessed with so many drug options.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
6 posts
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