My Dad was diagnosed in late Dec. Since he is a veteran he has been seeing both VA doctors and non-VA doctors. Both doctors suggested a very similar treatment:
VA: Velcade (bortezomib) , dexamethasone (Decadron), and Cytoxan (cyclophosphamide).
Non -VA: Velcade, Decadron +/- Revlimid.
So my question is what would be the difference between Revlimid and Cytoxan, or are they the same just different name, and if they are different what has everyone's experience and difference been with the two?
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emilysfrost - Name: Emily
- Who do you know with myeloma?: Father
- When were you/they diagnosed?: December 2013
- Age at diagnosis: 65
Re: Velcade-Revlimid-dex vs. Velcade-Cytoxan-dex
We are on the CyBorD regimen, which is another name for what the combination of three drugs the VA doctor recommended.
I don't know what the difference is between Revlimid and Cytoxan, but I do know that Revlimid is often used for maintenance therapy on its own, after induction therapy.
There are side effects associated with each drug, that may be worth looking into.
So far, with CyBorD, we have experienced hiccups as a side effect. Another side effect we have experienced is anemia, but it's hard to say if it is drug induced, or myeloma induced. Anemia can be a side effect of CyBorD.
I don't know what the difference is between Revlimid and Cytoxan, but I do know that Revlimid is often used for maintenance therapy on its own, after induction therapy.
There are side effects associated with each drug, that may be worth looking into.
So far, with CyBorD, we have experienced hiccups as a side effect. Another side effect we have experienced is anemia, but it's hard to say if it is drug induced, or myeloma induced. Anemia can be a side effect of CyBorD.
Re: Velcade-Revlimid-dex vs. Velcade-Cytoxan-dex
Hi Emily and InQ, Revlimid (lenalidomide) and Cytoxan (cyclophosphamide) are actually in two really different categories of drugs.
Revlimid, which was derived from thalidomide, acts in several ways to inhibit the growth of myeloma cells...angiogeneise, immunomodulation and more. It is known as a 'novel agent', one of the newer drugs available.
Cytoxan, is a type of 'alkylating agent', a derivative from mustard gas! I had it when collecting my stem cells, and it is also used in treatment regimens, but at lower doses. This type of drug is known as 'high dose' chemotherapy.
If you type the drugs names into the 'search' box on the upper right hand corner of the page, you can get more detailed info on these drugs, including a sketch of the molecular framework.
Revlimid, which was derived from thalidomide, acts in several ways to inhibit the growth of myeloma cells...angiogeneise, immunomodulation and more. It is known as a 'novel agent', one of the newer drugs available.
Cytoxan, is a type of 'alkylating agent', a derivative from mustard gas! I had it when collecting my stem cells, and it is also used in treatment regimens, but at lower doses. This type of drug is known as 'high dose' chemotherapy.
If you type the drugs names into the 'search' box on the upper right hand corner of the page, you can get more detailed info on these drugs, including a sketch of the molecular framework.
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Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: Velcade-Revlimid-dex vs. Velcade-Cytoxan-dex
I wonder what the logic is between choosing one over the other.
Re: Velcade-Revlimid-dex vs. Velcade-Cytoxan-dex
InQ wrote: "I wonder what the logic is between choosing one over the other."
I wonder as well ....
I wonder as well ....
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emilysfrost - Name: Emily
- Who do you know with myeloma?: Father
- When were you/they diagnosed?: December 2013
- Age at diagnosis: 65
Re: Velcade-Revlimid-dex vs. Velcade-Cytoxan-dex
I am not a doctor, nor was I treated with either one of those induction therapies, for Revlimid was not available in Canada at that time, and even now, is not available for NDMM patients. I was treated with Velcade plus Dex, which worked well for me. Velcade (bortezomib) is the 'Bor' in those two regimens. Bortezomib belongs to yet another category of drugs ... the proteasome inhibitors. This type of drug interferes with the 'garbage disposal' mechanism of the quickly growing cancer cells. I think that all chemo drugs capitalize on the fact that cancer cells grow and multiply more quickly that normal cells do.
The difference in cost between Revlimid and Cyoxan is a lot! Revlimid is very expensive, as is bortezomib (Velcade). But I am not sure that that is the whole reason behind differences in treatments. It's possible that the doctors may not want to use the two novel agents, Revlimid and Velcade, upfront. Since myeloma tends towards relapse, they may want to save the Revlimid for later if needed, or for maintenance chemo, if offered after a transplant.
So I guess you should get back to the two clinics and ask more questions about the rationale behind the initial treatments. I didn't have either of these initial treatments, but have taken all four drugs...dex, Velcade, cytoxan and Revlimid during my treatments, but not bundled up all at once. This is probably more confusing than anything else, but myeloma is nothing if not a complicated disease to treat! Hope that helps!
The difference in cost between Revlimid and Cyoxan is a lot! Revlimid is very expensive, as is bortezomib (Velcade). But I am not sure that that is the whole reason behind differences in treatments. It's possible that the doctors may not want to use the two novel agents, Revlimid and Velcade, upfront. Since myeloma tends towards relapse, they may want to save the Revlimid for later if needed, or for maintenance chemo, if offered after a transplant.
So I guess you should get back to the two clinics and ask more questions about the rationale behind the initial treatments. I didn't have either of these initial treatments, but have taken all four drugs...dex, Velcade, cytoxan and Revlimid during my treatments, but not bundled up all at once. This is probably more confusing than anything else, but myeloma is nothing if not a complicated disease to treat! Hope that helps!
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Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: Velcade-Revlimid-dex vs. Velcade-Cytoxan-dex
You'll find that there are so many different ways that the doctors decide to choose one treatment regiment over another. I had Revlimid 15 mg 21 days on and 7 days off with 40 mg of Dex once per week as my induction therapy. I then went to an autologous stem cell transplant. I had quite a few problems with my induction, but I couldn't tell you if it was from the Revlimid or the Dex. My biggest problem was from severe cramping anywhere in my body at night, often every hour lasting for 10 - 15 minutes at a time. I never had any problems with the Revlimid lowering my blood counts, but some people do.
I didn't do maintenance after my transplant. When I relapsed after almost 3 years drug free my oncologist restarted me on the same regimen that I was on with induction except we reduced the Dex to 20 mg once a week. That has made a huge difference in how I'm tolerating treatment. My side effects from the Revlimid this time are bowel problems which vary from loose to hard and only happen maybe every other month. The other side effect that recently developed is a rash under my bottom lip and on the right side of my mouth. That I'm treating with a steroid ointment and occasionally an antihistamine when it itches.
So, do some research into all of the drugs and then ask the oncologists why each of them is recommending a different induction therapy. You and your husband have the final say over which way you want to go.
Nancy in Phila
I didn't do maintenance after my transplant. When I relapsed after almost 3 years drug free my oncologist restarted me on the same regimen that I was on with induction except we reduced the Dex to 20 mg once a week. That has made a huge difference in how I'm tolerating treatment. My side effects from the Revlimid this time are bowel problems which vary from loose to hard and only happen maybe every other month. The other side effect that recently developed is a rash under my bottom lip and on the right side of my mouth. That I'm treating with a steroid ointment and occasionally an antihistamine when it itches.
So, do some research into all of the drugs and then ask the oncologists why each of them is recommending a different induction therapy. You and your husband have the final say over which way you want to go.
Nancy in Phila
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NStewart - Name: Nancy Stewart
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 3/08
- Age at diagnosis: 60
Re: Velcade-Revlimid-dex vs. Velcade-Cytoxan-dex
Thanks for the replies, I think we will do some more research and also speak with both doctors again.
This journey started in Dec ... out of no where my father started to experience pain in his back and numbness in his legs and stomach it took three trips to the ER for them to finally do an MRI which found a tumor (plasmacytoma) that was compressing his spinal cord by this visit he was unable to stand on his own. Once they found the issue they immediately did surgery early the next morning. With removing the tumor they had to place a rod and pins in his spine.
Since then he has continued with physical therapy and had radiation for three weeks in January. Prior to this nothing ever showed up in his routine blood work. So I think we are all still feeling the shock and reality of the situation and may not be asking and thinking of all the right questions while at the doctors.
Thanks again. I am glad I found this site and support for our family.
This journey started in Dec ... out of no where my father started to experience pain in his back and numbness in his legs and stomach it took three trips to the ER for them to finally do an MRI which found a tumor (plasmacytoma) that was compressing his spinal cord by this visit he was unable to stand on his own. Once they found the issue they immediately did surgery early the next morning. With removing the tumor they had to place a rod and pins in his spine.
Since then he has continued with physical therapy and had radiation for three weeks in January. Prior to this nothing ever showed up in his routine blood work. So I think we are all still feeling the shock and reality of the situation and may not be asking and thinking of all the right questions while at the doctors.
Thanks again. I am glad I found this site and support for our family.
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emilysfrost - Name: Emily
- Who do you know with myeloma?: Father
- When were you/they diagnosed?: December 2013
- Age at diagnosis: 65
Re: Velcade-Revlimid-dex vs. Velcade-Cytoxan-dex
Greetings from gray Seattle!
Both of the combination regimens you mentioned are widely used in the U.S. for newly diagnosed multiple myeloma. They are both excellent choices for "induction therapy". To a large degree the choice of which combination to use in newly diagnosed myeloma is a matter of personal preference for most oncologists. There is no clear difference in outcomes for the majority of myeloma patients using these regimens. No "head to head" study comparing them has ever been done.
One exception to this would be for myeloma patients with the cytogenetic finding of 17p deletion or P53 mutation. Roughly 10-20% of myeloma patients have this finding and are considered "high risk" because these genetic changes suggest that the myeloma will be resistant to therapy and relapse sooner. In such a case using both of the "novel" agents Revlimid and Velcade together with dexamethsone would often be recommended.
I wish the best for your father in his struggles with this challenging disease.
Thank you for posting your question to the Beacon !
Both of the combination regimens you mentioned are widely used in the U.S. for newly diagnosed multiple myeloma. They are both excellent choices for "induction therapy". To a large degree the choice of which combination to use in newly diagnosed myeloma is a matter of personal preference for most oncologists. There is no clear difference in outcomes for the majority of myeloma patients using these regimens. No "head to head" study comparing them has ever been done.
One exception to this would be for myeloma patients with the cytogenetic finding of 17p deletion or P53 mutation. Roughly 10-20% of myeloma patients have this finding and are considered "high risk" because these genetic changes suggest that the myeloma will be resistant to therapy and relapse sooner. In such a case using both of the "novel" agents Revlimid and Velcade together with dexamethsone would often be recommended.
I wish the best for your father in his struggles with this challenging disease.
Thank you for posting your question to the Beacon !
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Dr. Edward Libby - Name: Edward Libby, M.D.
Beacon Medical Advisor
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