[chen5631867]

When to stop Velcade maintenance therapy?

by chen5631867 on Sat Sep 27, 2014 8:38 pm

She have been in remission on MMs in pancreatic organ and pelvic after ten months of RVD (Revlimid, Velcade, dex) treatments since November 2011, and collected stem cells without SCT in March 2012.

We talked with our doctor at VGH, who mentioned she may not do more chemos after more than thirty cycles of maintenance therapy by Velcade on this April in Taiwan, but she still take Velcade every five weeks as a cycle, two weeks on, three off, in Stanford.

We do not know when or how is the best time of off treatments. If anyone would give us some suggestions in this forum here. Thank you so much!

[Multibilly]

Re: When to stop Velcade maintenance therapy?

by Multibilly on Sun Sep 28, 2014 7:55 am

Chen,

There really is no agreement on how long one should do Velcade maintenance (or any other maintenance with another drug such as Revlimid). I assume that the Velcade treatment is subcutaneous (injections in the belly) Velcade and NOT intravenous delivery of Velcade?

The duration of maintenance depends on the doctor's philosophy, how the patient is responding to the Velcade, and whether the Velcade is causing toxicity, peripheral neuropathy or other quality-of-life problems.

Some doctors recommend one year for maintenance, others two years, and yet others recommend doing it forever (or until the maintenance drug causes a problem with the patient).

Dr. Voorhees's comments in this thread summarize the situation pretty well:

"Velcade or Revlimid maintenance therapy?," Beacon forum discussion started July 31, 2014

Maintenance therapy for multiple myeloma remains an area of intense interest and debate. If you ask 10 different myeloma specialists their thoughts, you will get several different answers. The guidelines are useful and explain the nuances, the risks and benefits, and the gaps in knowledge, but they are just guidelines with some recommendations based on solid phase 3 evidence and other guidelines based on expert opinion alone ...

You can do a search on "maintenance" in this forum to find more discussions on this subject.

I suggest that you read some of the other threads on this forum regarding maintenance, and then have an open discussion with the doctor on what his/her philosophy is on the duration of the maintenance therapy.

Good luck!

[Dr. Ken Shain]

Re: When to stop Velcade maintenance therapy?

by Dr. Ken Shain on Sun Sep 28, 2014 9:17 am

It is good to hear that the disease is well controlled.

In cases such as this, there remains to be a definitive answer. The choice of maintenance therapy (Velcade or Revlimid) and the length of maintenance will vary depending on the physician, the patient, tolerance / toxicities and the disease (response and risk). I think that Multibilly's post and the feedback from my co-Advisor Dr. Voorhees sum it up well.

[chen5631867]

Re: When to stop Velcade maintenance therapy?

by chen5631867 on Sun Oct 05, 2014 6:23 pm

Early this September I attended the seminar of a CML support group, inviting several doctors from medical centers in Taipei, and showing that all CML patients do not have to have an SCT if medicines are working, but patients shall not stop taking these medicines after several months or years without noting their doctors. If patients stop medications and the CML is relapsing, patients will die in the disorder of these resistance of medicines, and these doctors do have reports on these cases.

I do worry to tell her that she may have to perform maintenance therapy on her multiple myeloma forever, after her psychologist in Santa Clara, was a doctor in Mayo Clinic, mentioned she only has to treat the chemotherapy around five years. Is multiple myeloma a malignant cancer cancer than CML? Is it true?