Pharmacological therapies for the treatment of multiple myeloma
Pharmacotherapy is the cornerstone of myeloma treatment.
Doctors generally treat patients with two or more medications simultaneously. Some patients in intensive programs may take up to six different drugs.
They can be taken orally, by injection, or through a catheter surgically placed into a vein.
The main treatment strategies include:
Chemotherapy Chemo drugs destroy cancer cells, usually by stopping them from growing and dividing. These drugs include:
Chemotherapy is often part of a regimen that includes other classes of drugs.
Targeted therapy This type of drug focuses on specific genes or proteins in the cancer or in the tissues around it that help malignant cells survive. Targeted drugs prevent cancer cells from growing and spreading while limiting damage to healthy cells (a problem with chemotherapy drugs).
The American Cancer Society says the medications include:
- Proteasome inhibitors Drugs such as bortezomib (Velcade), carfilzomib (Kyprolis) and xazomib (Ninlaro) target specific enzymes in myeloma cells called proteasomes that digest proteins in the cells.
- Nuclear export inhibitors Selinexor (Xpovio) blocks a protein that myeloma cells use to evade the body’s natural defenses against cancer. It is given in combination with a steroid or proteasome inhibitor.
- immune factors These drugs have been shown to be effective against multiple myeloma by stimulating the immune system. Thalidomide (Thalidomide) and lenalidomide (Revlimide) are approved to treat newly diagnosed patients. Lenalidomide and pomalidomide (Pomalist) treat recurrent myeloma.
- Monoclonal antibodies Elotuzumab (Empliciti), daratumumab (Darzalex), and isatuximab (Sarclisa) bind to myeloma cells and mobilize your immune system to attack. These drugs also directly kill myeloma cells. Teclistamab-cqyv (Tecvayli) is a bispecific antibody. It can bind to both a white blood cell called a T cell and a myeloma cell at the same time to trigger an immune attack on the cancer cells.
- CAR T-cell therapy (CAR T-Cell Therapy) In this treatment, some T cells are removed from your blood. They are then altered in a laboratory so that they can identify and kill cancer cells before being reinfused into your body. Idecabtagene (Abecma) and ciltacabtagene autoleucel (Carvykti) target a protein called BCMA that is only found in myeloma cells. It is approved to treat multiple myeloma that has not responded to other treatments.
Other drug treatments Patients with multiple myeloma are often treated with steroids, such as prednisone (Deltasone), either alone or with a combination therapy. Steroids can fight inflammation and kill myeloma cells.
Other medications can help prevent bone damage caused by multiple myeloma from getting worse. These include bisphosphonates such as pamidronate (Aridia), zoledronic acid (Reclast), and a monoclonal antibody called denosumab (Prolia).
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Stem cell transplantation for multiple myeloma
One of the first decisions a doctor makes after making a diagnosis of multiple myeloma is whether a patient is a candidate for a stem cell transplant.
For some patients, such as those with other serious medical conditions, the risks of a stem cell transplant may outweigh the benefits.
But for people who are otherwise healthy to have a stem cell transplant, this may be the treatment of choice with the best prognosis.
Stem cells are cells found in the blood and bone marrow that develop into red blood cells, white blood cells, and platelets. A stem cell transplant aims to replace cancerous stem cells with healthy cells.
There are two types of implant:
Autologous Doctors collect stem cells from the patient’s blood, treat the patient with high doses of chemotherapy, and give the stem cells back to the patient intravenously. Stem cells make their way back into the bone marrow, where they begin to grow and multiply. Sometimes, doctors recommend patients to have a tandem transplant — two autologous transplants 6 to 12 months apart.
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Radiotherapy for multiple myeloma
Doctors may use radiation therapy to treat areas of bone that have been damaged by multiple myeloma, that don’t respond to chemotherapy, that are causing pain, or that are prone to fracture.
Clinical trials and experimental treatments
Researchers are striving to develop new therapeutic approaches for multiple myeloma, such as new drugs, new drug combinations, and new approaches to stem cell transplantation.
The Multiple Myeloma Research Foundation has an experiment that explores the concept of precision medicine, where treatment is based on the unique characteristics of a person’s immune system and cancer cells.
Scientists are also investigating the genes of myeloma cells in order to identify both standard and high-risk disease.