Multiple disciplinary teams are made up of different clinical experts who work together to provide a combination of treatments to treat a cancer patient. In this team variety of other medical and para-medical staff like nurses, pharmacists, dietitians, counselors are involved. The treatment plan of multiple myeloma depends upon the cancer stage and the overall health of the patient. The treatment goal is to provide an active life to the patient by eliminating myeloma cells, restricting tumor growth, controlling pain, and improving the quality of life of the patients. In many cases, multiple myeloma treatment can manage cancer successfully without completely curing the disease.
Multiple myeloma treatment for patients without symptoms
Multiple myeloma patients who are in the early stage usually not having any symptoms. The doctor usually monitors patients closely to observe changes at every beginning. This treatment approach is termed active surveillance. In this treatment phase, if the doctor has noticed that the patient starts bone thinning or osteoporosis, then bisphosphonates may periodically infuse to the patient to reverse the condition. The doctor may also recommend target therapy or immunotherapy to prevent or delay myeloma.
Multiple myeloma treatment for patients with symptoms
The treatment approach for patients with symptoms is to control disease along with improvement of quality of life. In this treatment phase, supportive care plays an important role to provide symptomatic relief and maintaining the nutritional level of the patients. Drug therapy like chemotherapy, targeted therapy, and a combination of both the therapies with or without steroids are considered disease-directed treatments. Bone marrow or stem cell transplantation is another treatment option. Surgical interventions, radiotherapy are other treatment options for a specific condition. The treatment plan for multiple myeloma has three phases:
Induction therapy helps cancer control rapidly for relieving symptoms.
Consolidation occurs through chemotherapy or bone marrow/stem cell transplantation.
Maintenance therapy is to prevent cancer recurrence for a prolonged period.
Medications used in multiple myeloma
Medications like chemotherapy, targeted therapy, immunomodulatory drugs, steroids, and one-modifying drugs are administered through systemic routes. Therefore, the administration of these medications is also termed systemic therapy. In this therapy, drugs are directly administered through the bloodstream to reach cancer cells for destroying them. A medical oncologist, a doctor who specializes in treating cancer with medication can prescribe the medication. The medication is given under his/her supervision. Cancer medications have different side effects that also need to take care of. A patient can receive a single or combination of medication depending upon the treatment plan.
The aim to prescribe chemotherapy is to destroy cancer cells by restricting their growth, and multiplication. A specific schedule is followed to maintain the number of chemotherapy cycles require for the individual patient. The chemotherapy is given for some time. Usually, chemotherapy is given
A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period. A patient usually receives combinations of different drugs at the same time. Cyclophosphamide, doxorubicin, cisplatin, melphalan, etoposide are different chemotherapeutic drugs available for myeloma treatment.
Targeted therapy targets cancer-specific genes, proteins, or the tissue environment essential for cancer growth and survival.
Proteasome inhibitors like bortezomib, carfilzomib, and ixazomib target proteasomes (specific enzymes) that digest protein in the cells. Myeloma cancer that produces a lot of proteins can specifically be treated with this type of drug. Carfilzomib and ixazomib are the treatments of recurrent myeloma.
Histone deacetylase inhibitors. Panobinostat is a histone deacetylase inhibitor prescribes to treat recurrent myeloma by activating genes that slow down or stop the growth of cancer cells.
Monoclonal antibodies like elotuzumab and daratumumab bind to myeloma cells and the patient’s immune cell remove them. These medications are usually given in combination with other drugs. Isatuximab-irfc is an FDA-approved monoclonal antibody use for treating adults with multiple myeloma in combination with dexamethasone and pomalidomide.
Nuclear export inhibitors like Selinexor are a targeted therapy. Selinexor is administered in combination with dexamethasone. This combination is used to treat adults with recurrent multiple myeloma that has come back after at least 4 previous treatments.
B-cell maturation antigen (BCMA) likeBelantamab mafodotin-blmf is an antibody-drug conjugate approved by the FDA. This drug prescribes for an adult patient with recurrent or refractory multiple myeloma who has received at least 4 previous treatments.
Thalidomide, lenalidomide, and pomalidomide are the drugs that come under this section to stimulate the immune system. These drugs also prevent to development of new blood vessels that are essential for forming and feeding myeloma cells.
Prednisone and dexamethasone are prescribed single or in combination with targeted novel therapy or chemotherapy.
Bisphosphonates and Denosumab are two types of bone-modifying drugs to prevent bone loss in patients with myeloma. The drug choice depends upon individual patient factors. The aim to prescribe these types of medications is to strengthen the bone and reduce bone pain and the risk of fractures.
Bone marrow transplantation/stem cell transplantation
This is a medical procedure to replace the cancerous bone marrow with healthy and highly specialized cells, called hematopoietic stem cells. These cells help to develop into healthy red blood cells, white blood cells, and platelets in the bone marrow. Hematopoietic stem cells are blood-forming cells found both in the bloodstream and in the bone marrow. Allogeneic (ALLO) and autologous (AUTO) are two types of stem cell transplantation procedures are available. ALLO uses donated stem cells, while AUTO uses the patient’s stem cells. AUTO is more commonly used in multiple myeloma. Ongoing clinical trials check the efficacy of ALLO against multiple myeloma.
Radiation treatment helps to reduce pain symptoms because of bone damage in patients with multiple myeloma. But a doctor may not prescribe radiation therapy because of the side effect burden.
Surgical intervention cannot directly treat multiple myeloma. But surgery can provide symptomatic relief, especially for fractures, and plasmacytomas.