[JimNY]

Re: Velcade or Revlimid maintenance therapy?

by JimNY on Fri May 15, 2015 3:04 pm

Hi Mrozdav,

I think that Coop is receiving Velcade as maintenance therapy, and it's the only drug in the treatment regimen he's receiving. So that probably is why his doctor is less concerned about rigorously checking blood counts.

Also, I wouldn't worry too much about your veins, unless you'll be getting the Velcade by in­fusions rather than subcutaneous injections. The subcutaneous injections don't require the drug to be injected into a vein, just under the skin someplace.

Good luck!

[mrozdav]

Re: Velcade or Revlimid maintenance therapy?

by mrozdav on Fri May 15, 2015 3:28 pm

JimNY, It is not the injections in my abdomen that I am concerned about, but rather the weekly blood tests.

[JPC]

Re: Velcade or Revlimid maintenance therapy?

by JPC on Fri May 15, 2015 5:12 pm

Recent studies indicate that Velcade treatment tends to mitigate the adverse results of some of the high (and mid) risk cytogenitics. For example, I have read that a few doctors at this time consider t(4,14) to be almost similar to standard risk, if given Velcade induction and main­te­nance (Dr. Morgan at UAMS and Dr. Rajkumar, for example, have said this). Velcade main­tenance also has been proven effective in terms of RVD maintenance in a recent study by Dr. Lonial for del(17p).

Revlimid at this time is oral, and Velcade is not, which makes Revlimid more appropriate, logistically, for maintenance. Revlimid, however, I understand, is somewhat more expensive, so in Europe, with a more nationalized health care system, they have started to use Velcade more for maintenance (I am guessing at least in part due to economics). I understand that European studies report that very generally they are very roughly about of equal effectiveness (based on populations, not individuals). Dr. Palumbo has said this. Though I am sure that there are specific cases where one or the other is preferred.

There are also some studies that the Revlimid combo is not good post ASCT due to interaction with melphalan increases risk for secondary cancers. If this is a concern, Velcade is more appropriate than Revlimid.

I am not 100% sure of the exact approval status of ixazomib (oral formulation of Velcade), but I believe the latest is that it is approved for RRMM, but not yet for maintenance. At such time that ixazomib is approved, I foresee that it will be probably at least equivalent to Revlimid for the maintenance application.

Regards,

[zara]

Re: Velcade or Revlimid maintenance therapy?

by zara on Wed May 20, 2015 8:59 am

Hey Mark,

How did your maintenance go? Are you on lenalidomide? Did you do the stem cell transplant?

I did the induction therapy of Velcade + dexa + cyclo for 6 months and am in remission now.

I skipped the ASCT but my doc has put me on Revlimid 10 mg daily and dexamethasone 10 mg weekly. I have to say, I do not like it. I thought that after my chemo I would begin to feel stronger and more normal again. I still feel weak and tired most of the time. Also, the dex gives me mood swings and disturbed nights. Do you feel like that?

I am considering telling my doc to stop all this so that I can lead a normal, or closer to normal, life.

Just wondering if it is the same for everyone.

Regards,
Zehra

[K_Shash]

Re: Velcade or Revlimid maintenance therapy?

by K_Shash on Thu May 21, 2015 8:42 am

Hello Zara,

I have the IgG kappa 'trisomies only' mutiple myeloma.

I just completed my 5 x 4-week cycles of VRD (15 mg Revlimid daily, 3 weeks and 1 week off, 20 mg dex once every week, and Velcade) induction therapy and I was hoping the 6th cycle would be the last. However, I had a nasty flu and high fever in the middle of the 4th cycle, all treatment was stopped for a week, and my kappa numbers shot up, due to the reaction to the flu, in my opinion.

I started the induction therapy in mid December when my kappa FLC reading was 1,070. That came down to 127, 48, 25, but rose to 45 and now back down to 24 after each 4-week cycle.

I, too, have decided to skip ASCT and I am looking forward to a much reduced dosage (and no Velcade shots) of Revlimid and dex. However, my oncologist and another myeloma expert are both advising that I continue this induction therapy for a number of more cycles, til my kappa FLC's are in single digits and stay there. I would not have get any BMB.

I would appreciate it very much if you let me know what levels of these readings you achieved in 6 months. I do not plan to go against the advice of my 'experts,' but I am quite concerned about the prolonged effect on my quality of life (no golf or outdoor activities, sensitivity to in­fections, having to stay away from the grandkids, etc.).

K_Shash