What Drug Therapies Are Available For Myeloma Treatment?

Multiple Myeloma is a form of cancer. It forms in a type of white blood cells called plasma cells. Plasma cells are needed to fight infections in the body. They do this by making antibodies that recognize and attack germs. When a person has Multiple Myeloma cancer cells accumulate in the bone marrow and crowd the healthy blood cells.

There are many types of treatment for Multiple Myeloma, which you can read about below.

Chemotherapy

Chemotherapy is a type of drug that is used to destroy or control cancerous cells.

Chemotherapy (chemo) is using drugs to destroy or control cancer cells. These drugs can be taken orally or given in a vein or a muscle. They enter the bloodstream and reach just about all regions of the body.

Often these drugs are combined with different forms of drugs such as corticosteroids and immuno-modulating agents (drugs that will alter the patient’s immune response). If a stem cell transplant is intended, most physicians avoid using certain drugs, such as melphalan, that can damage bone marrow.

Chemotherapy drugs kill cancer cells but can also damage normal cells. They’re given carefully to prevent or lessen the side effects of chemotherapy. These side effects depend on the type and dose of drugs given and how long they’re taken.

Chemotherapy often Results in low blood counts, which can cause the following:

For instance, drugs can be given together with the chemo to prevent or reduce nausea and vomiting.

Besides these temporary side effects, some chemo drugs can permanently harm certain organs like the kidneys or heart. The probable dangers of these drugs are closely balanced against their advantages, and the role of these organs is closely monitored during therapy. If serious organ damage occurs, the drug that caused it is stopped and replaced with another.

Corticosteroids

Corticosteroids, such as dexamethasone and prednisone, are an essential part of the treatment of multiple myeloma. They may be used alone or blended with other drugs as a component of treatment. Corticosteroids are also used to help reduce the nausea and vomiting that chemo may cause.

• High blood glucose
• Increased appetite and weight gain
• Issues sleeping
• Changes in mood (some people become irritable or”hyper”)

When used for quite a long time, corticosteroids also suppress the immune system. This increases the chance of serious infections. Steroids may also weaken bones.

Immunomodulating agents

The way immunomodulating agents influence the immune system is not entirely known. Three immunomodulating agents are used to treat multiple myeloma. Since the other immunomodulating agents are associated with thalidomide, there is concern that they might also lead to birth defects. That’s why all these drugs can only be acquired through a special program run by the drug company that makes them.

Because these drugs can increase the chance of serious blood clots, they are usually given together with aspirin or a blood thinner.

When it was discovered to cause birth defects, it had been removed from the market. Later, it became accessible again as a treatment for multiple myeloma. Side effects of thalidomide may include nausea, fatigue, severe constipation, and painful nerve damage (neuropathy). The neuropathy can be acute, and may not go away after the drug is stopped. There’s also an increased risk of serious blood clots that begin in the leg and can travel to the lungs.

In addition, it can lead to painful nerve damage. The danger of blood clots isn’t as large as that seen with thalidomide, but it’s still increased.

In patients, where the myeloma is in remission after a stem cell transplant or first therapy, lenalidomide might be given for maintenance treatment to prolong the remission.

Pomalidomide (Pomalyst) can also be associated with thalidomide and is used to treat multiple myeloma. The risk of nerve damage isn’t as severe as it is with the other immunomodulating drugs, but it is also connected to an increased risk of blood clots.

Proteasome inhibitors

Proteasome inhibitors work by stopping receptor complexes (proteasomes) in cells by breaking down proteins important for controlling cell division. They seem to affect tumor cells over ordinary cells, but they’re not without side effects.

Bortezomib (Velcade) was the first of the kind of drug to be approved, and it is frequently used to treat multiple myeloma. It might be especially beneficial in treating myeloma patients with kidney issues. It is injected into a vein (IV) or under the skin, one or two times a week.

Common side effects of this drug include nausea and vomiting, fatigue, diarrhea, constipation, fever, decreased appetite, and reduced blood counts. The platelet count (which could cause easier swelling and swelling ) and the white blood cell count (which could increase the chance of severe infection) are most often affected. Bortezomib can also lead to nerve damage (peripheral neuropathy) that can result in problems with numbness, tingling, or even pain in the feet and hands. The risk of nerve damage is significantly less when the drug is given under the skin. Some individuals develop shingles (herpes zoster) while taking this drug. To help prevent this, your physician may have you take an anti-viral medicine (such as acyclovir) while you take bortezomib.

In patients in which the myeloma was put into remission after a stem cell transplant or first therapy, bortezomib may also be given for maintenance therapy to prolong the remission.

Carfilzomib (Kyprolis) is a newer proteasome inhibitor which can be used to treat multiple myeloma in patients that have been treated with different drugs that didn’t work. It is given as an injection into a vein (IV), frequently at a 4-week cycle. To prevent issues like allergic reactions during the infusion, the steroid drug dexamethasone is often given before every dose in the initial cycle.

Common side effects include fatigue, nausea and vomiting, diarrhea, shortness of breath, fever, and low blood counts. The blood counts most often affected are the platelet counts (which could cause easier swelling and swelling ) and the red blood cell count (which may result in fatigue, shortness of breath, and being light ). Individuals on this drug can also have more serious issues, such as pneumonia, heart problems, and liver or kidney failure.

Ixazomib (Ninlaro) is a proteasome inhibitor that’s a capsule taken by mouth, typically once a week for 3 months, followed by a week off. This drug is usually given after other drugs are tried.

Common side effects of this drug include nausea and vomiting, diarrhea, constipation, swelling in the feet or hands, back pain, and a reduced blood platelet count (which could cause easier swelling and swelling ). This drug may also cause nerve damage (peripheral neuropathy) that may result in problems with numbness, tingling, or even pain in the feet and hands.

HDAC inhibitors are a group of drugs which could affect which genes are active or turned on inside cells. They do so by interacting with proteins in chromosomes known as histones.

Panobinostat (Farydak) is an HDAC inhibitor which can be used as a treatment for patients that have been treated with bortezomib and an immunomodulating agent. It’s a capsule, typically taken 3 times per week for two weeks, followed by a week off.

Common side effects include nausea (which may be severe), feeling tired, nausea, vomiting, loss of appetite, swelling in the arms or legs, fever, and fatigue. This drug can also have an effect on blood cell counts as well as the blood levels of certain minerals (such as potassium, sodium, and calcium). Less common but nevertheless serious side effects may include bleeding inside the body, liver damage, and changes in heart rhythm, which can occasionally be life threatening.

Monoclonal antibodies

Antibodies are proteins produced by the body’s immune system to help fight infections. Man-made versions (monoclonal antibodies), can be made to attack a particular target, like proteins on the surface of myeloma cells.

This is thought to kill the cancer cells directly and also to assist the immune system attack them too. This drug is used mainly in conjunction with different forms of drugs, even though it may also be used alone in patients who have already had many different remedies for their myeloma. It is given as an infusion into a vein (IV).

This drug can cause a reaction in some people while it is being granted or in a few hours later, which can occasionally be severe. Symptoms may include coughing, wheezing, trouble breathing, tightness in the throat, a runny or stuffy nose, feeling dizzy or lightheaded, itching, rash, and nausea.

Other side effects may include nausea, fatigue, back pain, fever, and cough. This drug may also lower blood cell counts, which may increase the risk of infections and swelling or bleeding.

This is believed to assist the immune system attack on the cancer cells. This drug is used mainly in patients who have had other remedies for their myeloma. It is given as an infusion into a vein (IV).

This drug can cause a reaction in some people while it is being granted or within a few hours later, which can occasionally be severe. Symptoms may include fever, chills, feeling dizzy or lightheaded, rash, wheezing, difficulty breathing, tightness in the throat, or a runny or stuffy nose.

Other common side effects with this drug include fever, fatigue, loss of appetite, diarrhea, constipation, cough, nerve damage leading to weakness or numbness in the hands and feet (peripheral neuropathy), upper respiratory tract infections, and pneumonia.

Although a single drug could be used to treat multiple myeloma, it’s better to use at least 2 or 3 different sorts of drugs in conjunction because the cancer responds better. For example:

The choice and dose of drug therapy depends on several factors, including the stage of the cancer, the age and kidney function of the individual in addition to how frail the patient could be. If a stem cell transplant is planned, most physicians avoid using certain drugs, like melphalan, that could damage the bone marrow.

Myeloma cells may weaken and even break bones. Drugs known as bisphosphonates can help bones remain strong by slowing down this procedure. They can also help reduce pain in the diminished bone(s). At times, pain medications such as NSAIDs or narcotics will be given together with bisphosphonates to help control or decrease the pain. Bone pain may be a difficult symptom to treat during and following treatment for myeloma.

Most patients are treated once per month initially, but they might be able to be treated less frequently later on if they’re doing well. Treatment with a bisphosphonate helps prevent additional bone damage in multiple myeloma patients.

Patients complain of pain and physicians realize that portion of the jaw bone are compromised This may cause an open sore that does not heal. It may also lead to tooth loss in that region. The jaw bone may also become infected. Doctors aren’t certain why this occurs or how best to stop it, but having jaw surgery or having a tooth removed can cause this issue. Steer clear of these procedures when you are taking a bisphosphonate. Many physicians recommend that patients have a dental checkup before beginning treatment. This way, any dental issues can be cared for before starting the drug. If ONJ does happen, the doctor will stop the bisphosphonate therapy.

One way to prevent these dental procedures is to maintain good oral hygiene by flossing, brushing, making certain dentures fit properly, and having regular dental checkups. Any tooth or gum infections should be treated straight away. Dental fillings, root canal procedures, and tooth implants don’t appear to lead to ONJ.