[liranraz]

Treatment after Velcade, Revlimid, and Darzalex?

by liranraz on Mon Jun 18, 2018 9:30 am

Hi,

My mother, who is almost 71 years old, was diagnosed 4 years ago with multiple myeloma. At the peak, her IgG level was 4100, with damage to the bones (no damage to kidney).

Her treatment so far:

• Bortezomib (Velcade); duration: 6 months
• No medication; duration: 12 months
• Lenalidomide (Revlimid); duration: 30 months (stable IgG level at: 1700)

After IgG level climbed to 2800, free kappa 70, she started with:

• Daratumumab (Darzalex), duration: 2 months (ongoing) (IgG 2500, free kappa 60)

Since monotherapy with daratumumab has only partial success, they are considering which treatment to take next.

We have a few options available from the medical insurance.

Can you recommend on which single / combination of medicine to continue with?

Thanks,
Liran.

[Nancy Shamanna]

Re: Treatment after Velcade, Revlimid, and Darzalex?

by Nancy Shamanna on Tue Jun 19, 2018 9:21 am

Hello Liranraz,

Welcome to the forum but am sorry that your mother is so ill with myeloma. I am not a doctor, and also couldn't really know what your options are now. I had a couple of thoughts though.

It seems that the Velcade as an initial treatment was effective since she was able to go without treatments after that for 12 months. So possibly she could try that again.

Also, from what I have read, the treatment Darzalex, a monoclonal antibody, does work most effectively when combined with an immunomodular agent, such as Revlimid or Pomalyst, or with a proteasome inhibitor, such as Velcade, plus dexamethasone. So if 'triplet' combinations are available to you, that might help (a 'doublet' combination might be Velcade plus dex, whereas a 'triplet' combination might be Darzalex plus Velcade plus dex.) Not sure if she has had dexa­meth­a­sone added to her treatments yet?

So hopefully you could have some ideas to discuss with your hematological oncologist as to how to help your mother. Let us know what you can do next!

[Pippy]

Re: Treatment after Velcade, Revlimid, and Darzalex?

by Pippy on Tue Jun 19, 2018 9:57 am

Liran,

Your mother is fortunate to have you. I, too, am not a doctor, but I would highly recommend getting a second opinion, if possible, from a myeloma specialist. There are so many effective combinations, but I've heard doctors say prescribing the drugs is an art, as well as a science.

I'm not sure how your insurance works, but I would get a doctor's recommendation, and then try to get the insurance to cover it. I hope that is possible where you are.

I agree with Nancy that triplets are preferred now. I'm on Darzalex, Pomalyst, and dexa­meth­asone, and it's very effective so far in my case. Everyone is different, but adding to the mono­therapy would seem to me to be a good idea. It's such a complicated treatment landscape that you really need someone who deals with myeloma and all the rapid changes going on to best help your mother and her particular case.

I wish you both all the best.

Courtenay

[liranraz]

Re: Treatment after Velcade, Revlimid, and Darzalex?

by liranraz on Tue Jun 19, 2018 3:11 pm

Hi,

Thanks. Answering your question: Revlimid and Darzalex were given with dexamethasone.

Liran

[liranraz]

Re: Treatment after Velcade, Revlimid, and Darzalex?

by liranraz on Mon Jul 02, 2018 8:13 am

Hi,

After consulting her doctor, my mother will be starting a new treatment which will include Pomalyst (pomalidomide), Empliciti (elotuzumab), and dexamethasone.

I'll post some of her blood test results when they become available.

Liran