Why add in Chemo with the Dex and Revmilid treatment? Thoughts on the benefits of this. My Dad's initial Dr. is retiring and so we have gone to a new one who has suggested he add Chemo to his plan. I have read of controlling the myeloma with and without chemo. My dad has no lesions or bone affect yet, but is 74. Wondering if such aggressive treatment is the right thing for him at his age. My Mom passed away after a very short and brutal battle with melanoma last December (I am sure this is making me extra nervous). My dad does not want to repeat her misery and I can't blame him Thoughts? Would love some extra opinions and experiences to make an informed decision.
Thank you!
Forums
Re: Why Chemo?
I'm a bit confused by your question. Rev and Dex (Rd) are chemo agents themselves. What specific "chemo" drugs are they asking you add to the Rd mix? If he has bone issues, adding Zometa might be very prudent and worth the minor side effects.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Why Chemo?
Dex and Rev were described to us as "biologicals" and not chemo by both doctors, though used to a similar affect - fight off the cancer. His chemo is the Bortezomib and he will get two injections per week. He is also going to have the bone treatment once per month. At this time his bones are ok. He has had the bone scan and it came back good.
My question I guess is the new Dr added this extra drug to the list and I just wondered if those living this have found that to be a benefit worth the side affects. It sounds harsher than the Dex and Rev. It's just a lot of strong medicine for any person to take and he is 74, which seems older than most of the folks I have read about on here, so I worry if it is too much. He is otherwise pretty healthy and only found out he was sick due to routine blood work run, when he had to replace his pacemaker/defibulator recently.
My question I guess is the new Dr added this extra drug to the list and I just wondered if those living this have found that to be a benefit worth the side affects. It sounds harsher than the Dex and Rev. It's just a lot of strong medicine for any person to take and he is 74, which seems older than most of the folks I have read about on here, so I worry if it is too much. He is otherwise pretty healthy and only found out he was sick due to routine blood work run, when he had to replace his pacemaker/defibulator recently.
Re: Why Chemo?
OK, boretezomib is Velcade. So the question is VRd versus Rd.
The biggest issue with Velcade is peripheral neuropathy (PN), which is annoying and sometimes debilitating nerve pain that can show up in different degrees in your feet and elsewhere.
There is a new subcutaneous form of Velcade (aka subq Velcade), which is the route you definitely want to go if you are going to consider this. Subq Velcade demonstrates much less PN than IV administered Velcade, but it is not perfect in this regard. Some folks have no issues with PN whatsoever on Velcade. For others it may be just temporary. For others, it is permanent. If you do decide to go the Velcade route, it is important that your Dad be very vocal and upfront with your doc regarding any PN issues so that the doc can address this during the treatment (i.e. lower the dose or eliminate it). You don't want to have him be stoic about the situation and end up with permanent PN.
Some docs will argue for VRd to achieve a deeper upfront response. Others will withhold either the R or the V (and just go with Rd or Vd) and then save one of the remaining drugs for a later time should he relapse or become refractory (resistant to the drug). In part, the choice also depends on his level of disease and his cytogenetics (genetic mutations related to multiple myeloma).
Ask your doc what plan B and C are down the line should he become relapse/refractory (R/R) to VRd.
Others on this forum will likely comment on how they chose one cocktail over the other.
Hope this helps.
The biggest issue with Velcade is peripheral neuropathy (PN), which is annoying and sometimes debilitating nerve pain that can show up in different degrees in your feet and elsewhere.
There is a new subcutaneous form of Velcade (aka subq Velcade), which is the route you definitely want to go if you are going to consider this. Subq Velcade demonstrates much less PN than IV administered Velcade, but it is not perfect in this regard. Some folks have no issues with PN whatsoever on Velcade. For others it may be just temporary. For others, it is permanent. If you do decide to go the Velcade route, it is important that your Dad be very vocal and upfront with your doc regarding any PN issues so that the doc can address this during the treatment (i.e. lower the dose or eliminate it). You don't want to have him be stoic about the situation and end up with permanent PN.
Some docs will argue for VRd to achieve a deeper upfront response. Others will withhold either the R or the V (and just go with Rd or Vd) and then save one of the remaining drugs for a later time should he relapse or become refractory (resistant to the drug). In part, the choice also depends on his level of disease and his cytogenetics (genetic mutations related to multiple myeloma).
Ask your doc what plan B and C are down the line should he become relapse/refractory (R/R) to VRd.
Others on this forum will likely comment on how they chose one cocktail over the other.
Hope this helps.
Last edited by Multibilly on Mon Jan 27, 2014 1:35 pm, edited 2 times in total.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Why Chemo?
Daughter the "chemo" you mention is also know as Velcade I believe and works much the same as the rev, Dex is a steroid and not a treatment in and of its self. I was treated with it and the steroid prednisone with very good results. I don't know why rev was no included in my treatment or why I'm no on a maintenance, but it worked and that's the important thing.
I was 70 at diagnoses and I don't believe there is any reason to avoid what the doctor has ordered, it seems to be a standard today.
I wouldn't worry before you have a reason. This is a nasty disease all by itself, without worrying ahead of time. This site is great and I would bring your concerns here to verify them. You'll be tested enough before it's over.
I was 70 at diagnoses and I don't believe there is any reason to avoid what the doctor has ordered, it seems to be a standard today.
I wouldn't worry before you have a reason. This is a nasty disease all by itself, without worrying ahead of time. This site is great and I would bring your concerns here to verify them. You'll be tested enough before it's over.
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Wayne K - Name: Wayne
- Who do you know with myeloma?: Myself, my sister who passed in '95
- When were you/they diagnosed?: 03/09
- Age at diagnosis: 70
Re: Why Chemo?
Regarding the comment that Velcade works much the same as Revlimid, this isn't quite accurate. They actually use very different mechanisms.
Velcade is what is known as a proteasome inhibitor. Revlimid is an Immunomodulatory (aka IMiD) drug. Proteasome inhibitors work by interfering with the cancer cell's ability to reproduce and live eternally (which is not a natural thing for a cell to do). On the other hand, IMiDs help specific front line immune cells known as natural killer cells to recognize and go after the cancer cells.
They really are quite different drugs. But they can work synergistically for a better overall effect. Unfortunately, you also need a steroid like Dex to make either of them work effectively.
Velcade is what is known as a proteasome inhibitor. Revlimid is an Immunomodulatory (aka IMiD) drug. Proteasome inhibitors work by interfering with the cancer cell's ability to reproduce and live eternally (which is not a natural thing for a cell to do). On the other hand, IMiDs help specific front line immune cells known as natural killer cells to recognize and go after the cancer cells.
They really are quite different drugs. But they can work synergistically for a better overall effect. Unfortunately, you also need a steroid like Dex to make either of them work effectively.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Why Chemo?
Multi, What is it about steroids that makes IMiD and MiB work more effectively?
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inquisitive
Re: Why Chemo?
From my readings, medication decisions are based on a variety of factors including risk stratification of the multiple myeloma, and whether your dad is a transplant candidate.
Using bortezomib appears to be useful if there is renal disease or high risk features.
The problem with adding bortezomib then includes toxicities, as Multibilly has nicely addressed.
Hopefully you can ask your doctor to explain his/her reasoning and feel more comfortable.
Using bortezomib appears to be useful if there is renal disease or high risk features.
The problem with adding bortezomib then includes toxicities, as Multibilly has nicely addressed.
Hopefully you can ask your doctor to explain his/her reasoning and feel more comfortable.
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Blee - Name: Blee
- Who do you know with myeloma?: me
- When were you/they diagnosed?: Oct 2013
- Age at diagnosis: 58
Re: Why Chemo?
Regarding: Multi, What is it about steroids that makes IMiD and MiB work more effectively?
See http://myeloma.org/pdfs/u-dex-eng_c1-web.pdf
Nearly all agents that are currently in use for treating myeloma don't work that effectively on their own, including the latest drugs that are in trial. They typically have to be paired up with a steroid or another drug that utilizes a different mechanism to provide any sort of significant effect.
For many, the dex component of treatment is what kicks people's asses wrt side effects.
See http://myeloma.org/pdfs/u-dex-eng_c1-web.pdf
Nearly all agents that are currently in use for treating myeloma don't work that effectively on their own, including the latest drugs that are in trial. They typically have to be paired up with a steroid or another drug that utilizes a different mechanism to provide any sort of significant effect.
For many, the dex component of treatment is what kicks people's asses wrt side effects.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Why Chemo?
I had all 3 - RVD and I thought the Dex was the worst of them. I attribute most of the side effects I experienced to the Dex. I wouldn't worry too much about adding Velcade, especially if it's the SubQ one. It's literally just 1 quick shot.
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RayGunter - Name: Ray Gunter
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Sept 2011
- Age at diagnosis: 38
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