sorry for my english i'm italian and there is no good forum in my native lanaguage,
like i said i have to take the decision between two line of therapy
1 Velcade melphalan prendisone VMP whitout maintenace
2 trial eloquent 1 is two arms study 1 with len +dex and 2 len+dex+elotuzumab until progression
what i have to do? my mother is 70 year's old now is in very good condition she don't want to cell transplant............for now untreated hemoglobin is 10,0 no bone damage 3.5 in the urine
i'm very sick i think to select eloquent 1 is a good choice?
i'm really scared about secondary cancer and vte
don't say to me is HER to make the decision she want i do that for her she don't use personal computer please help me please help me ........ i just cry more than her i know i have to be strong for her but is hard thank you
Forums
one week to decide the therapy for my mother
Last edited by manuel on Sun Oct 07, 2012 9:08 pm, edited 1 time in total.
Re: urgent tomorrow i have to select the therapy for my moth
Based on what you have said, the first option is the better one.
MPT and Ld are both excellent choices - and are very effective. Ld+Elotuzumab is an unknown, but should be as good as Ld bar the risk of toxicity.
No choice is irreversible. If she does not tolerate the treatment or does not respond to it, the treatment can be changed. If the doctor is not willing to change the treatment, I would change the doctor!
Addendum:
"MPT" in the text above is a mistake. It should be "MPV". See clarification in the post below.
MPT and Ld are both excellent choices - and are very effective. Ld+Elotuzumab is an unknown, but should be as good as Ld bar the risk of toxicity.
No choice is irreversible. If she does not tolerate the treatment or does not respond to it, the treatment can be changed. If the doctor is not willing to change the treatment, I would change the doctor!
Addendum:
"MPT" in the text above is a mistake. It should be "MPV". See clarification in the post below.
Last edited by myeloma1 on Sat Oct 06, 2012 9:38 am, edited 1 time in total.
Re: urgent tomorrow i have to select the therapy for my moth
thank you for your reply......
lenalidomide + dexhametasone is not a choice in italy for the first line therapy is only permissed in trials
MPT why : what i understand from my research and talking to many doctor is associated
with periferic neuropathy that may be irreversible and VTE, whorse response than VMP the only benefit seems to be the oral somministration ?
VMP: why is the better choice ?
i know i can change the terhapy if dosen't work but the second line treatment i think is always
associeted with minor response rate
thank you
lenalidomide + dexhametasone is not a choice in italy for the first line therapy is only permissed in trials
MPT why : what i understand from my research and talking to many doctor is associated
with periferic neuropathy that may be irreversible and VTE, whorse response than VMP the only benefit seems to be the oral somministration ?
VMP: why is the better choice ?
i know i can change the terhapy if dosen't work but the second line treatment i think is always
associeted with minor response rate
thank you
Re: urgent tomorrow i have to select the therapy for my moth
VMP is the better of the two choices that are available because you are scared of VTE and secondary cancers. Velcade dosing/schedule can be modified (weekly or subcutaneous) to reduce the risk of neuropathy. Second-line treatment is not always associated with a poor response rate.
Clarification: My first post was made very late at night because of your time-sensitive question. I apologize for confusing you - the term "MPT" should actually be "MPV" in the first post.
To summarize:
- MPV is better than len-dex or len-dex-elotuzumab considering that these are the only options based on your worry regarding second cancers and VTE
- She can always choose an alternative if there is poor tolerance or response
- The likelihood and severity of neuropathy associated with MPV can be minimized by using the drug weekly and/or subcutaneously and making appropriate dose adjustments if side effects do appear
Good luck!
Clarification: My first post was made very late at night because of your time-sensitive question. I apologize for confusing you - the term "MPT" should actually be "MPV" in the first post.
To summarize:
- MPV is better than len-dex or len-dex-elotuzumab considering that these are the only options based on your worry regarding second cancers and VTE
- She can always choose an alternative if there is poor tolerance or response
- The likelihood and severity of neuropathy associated with MPV can be minimized by using the drug weekly and/or subcutaneously and making appropriate dose adjustments if side effects do appear
Good luck!
Re: urgent tomorrow i have to select the therapy for my moth
first you don't have to apologize,thank you for your time,
yes i'm scared but my fear don't have to led me to the wrong choice
if there is a wrong or right choice at this problem
the scheme somministration for VMP is pethema gem 1 cycle of 6 weeks twice weekly bortezomib plus melpahalan and prendisone the first 4 days
and 5 cycle of 5 weeks one weekly bortezomib plus melpahalan
and prendisone the first 4 days
neither maintenance or subcutaneous is allowed in italy
subcutaneous iniection maybe will be possible at the beginnig of the new year.......
in the trial with elotuzumab if i have the "luck" of this arm there is near 100% overal rate response(33% VGPR, 66% PR)in the phase II study on pepole who receive only 1 line of therapy before i think in the first line it could be better
today morning i call the hospital and take a few days to decide for VMP or LEN+DEX + o - elotuzumab
you have a link for long therm study of VMP pethema without maintenance and LENALIDOMIDE + low dose dexametasone until relapse?
yes i'm scared but my fear don't have to led me to the wrong choice
if there is a wrong or right choice at this problem
the scheme somministration for VMP is pethema gem 1 cycle of 6 weeks twice weekly bortezomib plus melpahalan and prendisone the first 4 days
and 5 cycle of 5 weeks one weekly bortezomib plus melpahalan
and prendisone the first 4 days
neither maintenance or subcutaneous is allowed in italy
subcutaneous iniection maybe will be possible at the beginnig of the new year.......
in the trial with elotuzumab if i have the "luck" of this arm there is near 100% overal rate response(33% VGPR, 66% PR)in the phase II study on pepole who receive only 1 line of therapy before i think in the first line it could be better
today morning i call the hospital and take a few days to decide for VMP or LEN+DEX + o - elotuzumab
you have a link for long therm study of VMP pethema without maintenance and LENALIDOMIDE + low dose dexametasone until relapse?
Re: urgent tomorrow i have to select the therapy for my moth
If this is for induction or salvage therapy I would chose the ELOQUENT trial.
In either arm of the study you are getting excellent therapy -Rev dex is an excellent regimen by itself. The trial is trying to determine if the addition of elotuzumab improves clinical outcomes.
Both choices are good -- and cannot be compare directly because no head to head trials have been done.
Rev/dex and Rev/dex+elo should be well tolerated.
As myeloma researcher -- I will also suggest the trial especially if the trial has excellent phase 2 results, as is the case for ELOQUENT1/2 -- in both the newly diagnosed setting and relapse.
Myeloma1 is correct you will have to concern yourself with deep vein thrombosis prophyaxis -- but this may be an aspirin depending on your mother's other health issues.
Each option has a risk benefit ratio.
But again, wIthout all the details I would chose the ELOQUENT trial.
In either arm of the study you are getting excellent therapy -Rev dex is an excellent regimen by itself. The trial is trying to determine if the addition of elotuzumab improves clinical outcomes.
Both choices are good -- and cannot be compare directly because no head to head trials have been done.
Rev/dex and Rev/dex+elo should be well tolerated.
As myeloma researcher -- I will also suggest the trial especially if the trial has excellent phase 2 results, as is the case for ELOQUENT1/2 -- in both the newly diagnosed setting and relapse.
Myeloma1 is correct you will have to concern yourself with deep vein thrombosis prophyaxis -- but this may be an aspirin depending on your mother's other health issues.
Each option has a risk benefit ratio.
But again, wIthout all the details I would chose the ELOQUENT trial.
-
Dr. Ken Shain - Name: Ken Shain, M.D., Ph.D.
Beacon Medical Advisor
Re: urgent tomorrow i have to select the therapy for my moth
Thank you for your response for my mother is a first line therapy
She have no particullary comorbiditiy except osteoporosis and thyroid disfunction from many years ago
No bone disease no renal dysfunction. She is 70 years old is in very good condition.
The reason for the therapy is the low hemogoblin 10.0g/dl.
She have no particullary comorbiditiy except osteoporosis and thyroid disfunction from many years ago
No bone disease no renal dysfunction. She is 70 years old is in very good condition.
The reason for the therapy is the low hemogoblin 10.0g/dl.
Re: urgent tomorrow i have to select the therapy for my moth
Hello Manuel,
Sorry to hear about your mother.
I don't believe you have mentioned this anyplace yet, so I thought I would ask, since it might be relevant to the treatment decision.
Does your mother have any signs of having what many would call "high-risk" myeloma?
That is, does she have any chromosomal abnormalities that suggest she may have myeloma that is harder to treat?
Others here in the forum will be able to tell you what the current list of "high-risk" chromosomal abnormalities are. I can't keep track.
However, if she has high-risk disease, then it may be better to go with the VMP option. My understanding is that, between Velcade and Revlimid, Velcade is believed to be a better option for patients with high-risk chromsomal abnormalities.
Also, if she has high-risk disease, it may be worth considering more seriously whether she should have a stem cell transplant.
If your mother has not had tests carried out to determine whether or not she has high-risk disease, that is something she probably should do.
Best of luck to her (and to you),
R
Sorry to hear about your mother.
I don't believe you have mentioned this anyplace yet, so I thought I would ask, since it might be relevant to the treatment decision.
Does your mother have any signs of having what many would call "high-risk" myeloma?
That is, does she have any chromosomal abnormalities that suggest she may have myeloma that is harder to treat?
Others here in the forum will be able to tell you what the current list of "high-risk" chromosomal abnormalities are. I can't keep track.
However, if she has high-risk disease, then it may be better to go with the VMP option. My understanding is that, between Velcade and Revlimid, Velcade is believed to be a better option for patients with high-risk chromsomal abnormalities.
Also, if she has high-risk disease, it may be worth considering more seriously whether she should have a stem cell transplant.
If your mother has not had tests carried out to determine whether or not she has high-risk disease, that is something she probably should do.
Best of luck to her (and to you),
R
Re: urgent tomorrow i have to select the therapy for my moth
Thanks Ricardo.
The last time we see doctor few days ago, I ask to know about the cytogenetic abnormalities but the result is not yet available and the doctor say that this don't have influence on which therapy is better but like you i read that VMP can pass-by this problem so I'm confused.
The stem cell transplant is correlated with high dose chemo. She dosen't want this i know
but if that is our only choice maybe i have the power to convince her......
Sorry for my really poor English. I hope you understand anyway what i mean.
The last time we see doctor few days ago, I ask to know about the cytogenetic abnormalities but the result is not yet available and the doctor say that this don't have influence on which therapy is better but like you i read that VMP can pass-by this problem so I'm confused.
The stem cell transplant is correlated with high dose chemo. She dosen't want this i know
but if that is our only choice maybe i have the power to convince her......
Sorry for my really poor English. I hope you understand anyway what i mean.
Re: urgent tomorrow i have to select the therapy for my moth
i'm thinking about the quality of life with continuous therapy
this means possibly side effect like infection for all the therapy ?
len+dex and maybe the infusion of elotuzumab this treatment in theory have to
prolong PFS and maybe overall survival right? or what's the point for go on until relapse
I found on the net MPV pethema median PFS is 27,4 months and time to nexth therapy is 37,6
months but i didn't find overall survival... maybe is not yet reached
i know there is no long therm data on elotuzumab but for LEN low dose dex there is something?
now go to bed try to sleep .......thanks all of you
this means possibly side effect like infection for all the therapy ?
len+dex and maybe the infusion of elotuzumab this treatment in theory have to
prolong PFS and maybe overall survival right? or what's the point for go on until relapse
I found on the net MPV pethema median PFS is 27,4 months and time to nexth therapy is 37,6
months but i didn't find overall survival... maybe is not yet reached
i know there is no long therm data on elotuzumab but for LEN low dose dex there is something?
now go to bed try to sleep .......thanks all of you
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