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Re: Why Chemo?
If you're interested in more on why steroids, which suppress the immune system, are used together with anti-myeloma therapies to treat myeloma, there are a couple of Medical Advisor postings specifically on the subject (as there often are on these kinds of topics).
First, Dr. Voorhees addresses the issue when it comes to therapies such as Velcade and Revlimid:
https://myelomabeacon.org/forum/i-know-this-may-sound-really-silly-re-immunity-system-t665.html#p2697
Second, Dr. Shain addresses it when it comes to newer, monoclonal antibody therapies being developed to treat myeloma:
https://myelomabeacon.org/forum/dex-with-anti-myeloma-antibody-therapies-t2006.html
First, Dr. Voorhees addresses the issue when it comes to therapies such as Velcade and Revlimid:
https://myelomabeacon.org/forum/i-know-this-may-sound-really-silly-re-immunity-system-t665.html#p2697
Second, Dr. Shain addresses it when it comes to newer, monoclonal antibody therapies being developed to treat myeloma:
https://myelomabeacon.org/forum/dex-with-anti-myeloma-antibody-therapies-t2006.html
Re: Why Chemo?
One other suggestion when it comes to discussion of myeloma therapies. As we mentioned in this recent posting,
https://myelomabeacon.org/forum/mother-83-just-diagnosed-what-to-expect-t2674.html#p14487
there is a tendency, perhaps a growing tendency, among myeloma specialists to avoid the term "chemotherapy" when it comes to the targeted anti-myeloma therapies such as Velcade, Revlimid, and the more recent novel therapies, Kyprolis and Pomalyst.
Technically, it's not wrong to call these newer myeloma drugs "chemotherapy".
But, as was pointed out in the discussion thread that contains the posting we just mentioned, the newer, targeted myeloma therapies are very different than older, traditional chemotherapy drugs that kill a broad range of fast-growing cells in the body, whether they are myeloma cells are not.
Which is probably why there is some hesitation to use the term "chemotherapy" for the newer drugs.
https://myelomabeacon.org/forum/mother-83-just-diagnosed-what-to-expect-t2674.html#p14487
there is a tendency, perhaps a growing tendency, among myeloma specialists to avoid the term "chemotherapy" when it comes to the targeted anti-myeloma therapies such as Velcade, Revlimid, and the more recent novel therapies, Kyprolis and Pomalyst.
Technically, it's not wrong to call these newer myeloma drugs "chemotherapy".
But, as was pointed out in the discussion thread that contains the posting we just mentioned, the newer, targeted myeloma therapies are very different than older, traditional chemotherapy drugs that kill a broad range of fast-growing cells in the body, whether they are myeloma cells are not.
Which is probably why there is some hesitation to use the term "chemotherapy" for the newer drugs.
Re: Why Chemo?
Would you say the side effects cumulative? (Meaning worse each time) Or is the first go round a pretty accurate expectation of side effects during the entire treatment?
Thank you all for taking time to help us!
Thank you all for taking time to help us!
Re: Why Chemo?
Why has the new oncologist recommended adding Velcade? How has your father's response been to just the Revlimid and Dex? How long has your father been on his current regimen? What is the long term plan for your father for treatment? Lots of questions, but ones that would give us a better picture of what your father's treatment and response has been so far.
I haven't had Velcade. I'm treated with Rev and Dex and have had really good responses during induction and now at relapse. My oncologist said that he would add Velcade to my regimen if I didn't have a good response to Rev and Dex again. Well, I did and continue to have a good response.
Velcade and Revlimid are considered novel drugs because they are both targeted therapies which is different from the traditional chemotherapies that affect all of the cells of the body indiscriminately.
Make sure that you and your father ask your new oncologist all of the questions that you have and his reasoning behind his recommendations.
Nancy in Phila
I haven't had Velcade. I'm treated with Rev and Dex and have had really good responses during induction and now at relapse. My oncologist said that he would add Velcade to my regimen if I didn't have a good response to Rev and Dex again. Well, I did and continue to have a good response.
Velcade and Revlimid are considered novel drugs because they are both targeted therapies which is different from the traditional chemotherapies that affect all of the cells of the body indiscriminately.
Make sure that you and your father ask your new oncologist all of the questions that you have and his reasoning behind his recommendations.
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: Why Chemo?
Beacon Staff wrote: "there is a tendency, perhaps a growing tendency, among myeloma specialists to avoid the term "chemotherapy" when it comes to the targeted anti-myeloma therapies such as Velcade, Revlimid, and the more recent novel therapies, Kyprolis and Pomalyst. Technically, it's not wrong to call these newer myeloma drugs "chemotherapy"."
We ran into a similar discussion with our Onc/Hem doctor. She was saying that what we are receiving isn't really considered chemo. The regimen we are on is CyBorD. I can see why dex is not chemo, because it is a steroid. I can see why Bor is not chemo, as it is proteasome inhibitor, ie targeted. But Cy, seems to be chemo, in the way it works, as it is not targeted?
We ran into a similar discussion with our Onc/Hem doctor. She was saying that what we are receiving isn't really considered chemo. The regimen we are on is CyBorD. I can see why dex is not chemo, because it is a steroid. I can see why Bor is not chemo, as it is proteasome inhibitor, ie targeted. But Cy, seems to be chemo, in the way it works, as it is not targeted?
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inquisitive
Re: Why Chemo?
You're right, inquisitive. Cyclophosphamide (Cytoxan) is a traditional chemotherapy agent. It was first approved by the FDA as a cancer therapy more than 50 years ago. It's also closely related to melphalan and to Treanda (bendamustine), all of which are nitrogen mustard alkylating agents, and therefore are not considered "novel" myeloma therapies.
That having been said, when cyclophosphamide is used in the CyBord regimen, it is not being given at doses nearly as high as those used when it is used as a traditional chemotherapy agent, and the drug is also being given orally during the CyBord regimen, rather than by IV. The same is true for melphalan, for example, when it is used in combination with prednisone (the "MP" regimen) or Velcade and prednisone ("VMP") to treat myeloma patients.
High doses of cyclophosphamide are often used, however, as part of the stem cell harvesting process.
And high doses of melphalan are, of course, the therapeutic part of the stem cell transplant process -- which, as many note, really should be called "high dose therapy with autologous (own) stem cell rescue".
That having been said, when cyclophosphamide is used in the CyBord regimen, it is not being given at doses nearly as high as those used when it is used as a traditional chemotherapy agent, and the drug is also being given orally during the CyBord regimen, rather than by IV. The same is true for melphalan, for example, when it is used in combination with prednisone (the "MP" regimen) or Velcade and prednisone ("VMP") to treat myeloma patients.
High doses of cyclophosphamide are often used, however, as part of the stem cell harvesting process.
And high doses of melphalan are, of course, the therapeutic part of the stem cell transplant process -- which, as many note, really should be called "high dose therapy with autologous (own) stem cell rescue".
Re: Why Chemo?
Nancy,
He just began all treatment today. He was first diagnosed around Thanksgiving and had a bone marrow biopsy on Dec 17. Dr went out of the country and when she returned we went for results and she informed us she was closing her practice (Jan 12). This was when we switched to the new Dr. So other than 2 days of Dex he has had no other meds for this. Today he got his Velcade and was supposed to start the Rev, but we found out yesterday the old Dr apparently had not yet sent in his paper work to the Rev mfg, so he is still waiting in the Rev to arrive.
You pose some good questions which I will address next time we meet the Dr. We just met him for the first time last Thursday, so after 2 months of dragging on, we got a fast start (which I think is good) with the new Dr. but I admit, caught me a little off guard. The old Dr seem so nonchalant about it and the new Dr much more action oriented.
Thanks to everyone who taken the time to respond! It's a lot to take in and hearing your thoughts and suggestions is invaluable : )
He just began all treatment today. He was first diagnosed around Thanksgiving and had a bone marrow biopsy on Dec 17. Dr went out of the country and when she returned we went for results and she informed us she was closing her practice (Jan 12). This was when we switched to the new Dr. So other than 2 days of Dex he has had no other meds for this. Today he got his Velcade and was supposed to start the Rev, but we found out yesterday the old Dr apparently had not yet sent in his paper work to the Rev mfg, so he is still waiting in the Rev to arrive.
You pose some good questions which I will address next time we meet the Dr. We just met him for the first time last Thursday, so after 2 months of dragging on, we got a fast start (which I think is good) with the new Dr. but I admit, caught me a little off guard. The old Dr seem so nonchalant about it and the new Dr much more action oriented.
Thanks to everyone who taken the time to respond! It's a lot to take in and hearing your thoughts and suggestions is invaluable : )
Re: Why Chemo?
It sounds like having the new oncologist is good since the previous one was so non-chalant. If your father really hadn't started treatment before today, then the RVd regimen is quite common as a first line of treatment. He may have some side effects with the Velcade and with the Revlimid during the first couple of rounds of treatment, but they usually even out as the body becomes adjusted to having these drugs in its system.
What is particularly important with Velcade is that if your father begins to notice any changes in sensation in his feet or hands that he speak up about it. Peripheral neuropathy is known to be one of the possible side effects of Velcade. It can become quite debilitating if it isn't caught right as it begins. What usually is done if it begins to develop is that either the dose of Velcade is reduced or the frequency of receiving it is decreased.
All the best to your father and I hope he responds well to his treatment,
Nancy in Phila
What is particularly important with Velcade is that if your father begins to notice any changes in sensation in his feet or hands that he speak up about it. Peripheral neuropathy is known to be one of the possible side effects of Velcade. It can become quite debilitating if it isn't caught right as it begins. What usually is done if it begins to develop is that either the dose of Velcade is reduced or the frequency of receiving it is decreased.
All the best to your father and I hope he responds well to his treatment,
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
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