Understanding the different myeloma therapies available can be overwhelming. This is why we had Dr. Scott R. Goldsmith in our Newly Diagnosed Myeloma Patient Chapter explain the difference between immunotherapy and chemotherapy, what types of myeloma drugs are classified as chemotherapy and which as immunotherapy, the mechanisms behind them and the different combinations used for patients.
You can watch his presentation or read the highlights of this talk below.
Fifty years ago, there were hardly any treatments for myeloma. Over the last few decades, and especially in recent years, we've seen continued development in drug therapies thanks to the contributions that patients have made through participating in clinical trials.
Myeloma therapies are built upon success. Approved clinical trials have brought about more effective therapies for myeloma patients, like how the recommended therapies for newly diagnosed myeloma patients moved from doublet to triplet and even now quadruplet therapies in order to be more successful. It was discovered that drugs work differently and synergize, meaning the result of them together is more efficacious than their separate effects.
Different classes of drugs can be combined in myeloma therapy. Below we will describe the different classes of therapies that are prescribed to myeloma patients.
Chemotherapy works specifically by targeting cancer cells that are in the process of dividing. Cancer cells divide more frequently than normal cells, that's how they become cancerous, so they are targeted by two main mechanisms that will lead to cell death:
The disadvantage is that this may also affect healthy cells that are more likely to divide. This causes unwanted side effects such as hair loss, digestive issues, and skin problems.
The most common use of conventional chemotherapy in myeloma is using melphalan to kill myeloma cells before a stem cell transplant.
Separate from chemotherapy are novel therapies. Novel therapies try to target things that are specific to myeloma cells themselves like target signals, pathways, or machinery that myeloma cells rely on to survive. This is one of the staple treatments for newly diagnosed multiple myeloma.
We have three approved proteasome inhibitors for myeloma therapy:
- Velcade (bortezomib) - most commonly used
- Kyprolis (carfilzomib)
- Ninlaro (ixazomib)
Three of these therapies include:
- Revlimid (lenalidomide) - most commonly used
- Pomalyst (pomalidomide)
- Thalomid (thalidomide)
-vFarydak (Panobinostat) - out of the market
-vXPOVIO (Selinexor) - is used in later lines of treatment. It plugs up the myeloma cell so that it explodes on itself.
Immunotherapy treatments take advantage of immune system cells that already exist in the patient's body and use the immune system to attack cancer.
Because myeloma cells survive by "hiding" within the body and blood, the immunotherapies work to reveal the myeloma within the immune system and then direct the immune cells against the myeloma cells. The immunotherapy drugs often work well combined with novel therapies.
There are three main types of immunotherapies:
- Darzalex (daratumumab)
- Sarclisa (isatuximab)
- Empliciti (elotuzumab)
- BLENREP (belantamab mafodotin)
- Abecma (ide-cel)
- Carvykti (cilta-cel)
Having all these options is amazing and also overwhelming even for those who are practicing it. Doctors need to understand patients’ values, their medical issues and their long-term goals. They also need to know if the treatments are going to compete with each other or if they're going to work together in order to select the best option for their patients.
Patients who have participated in clinical trials have helped the myeloma treatment arsenal consistently improve. You can be an empowered patient by learning more about these therapies and having intelligent conversations with your doctor about what works best for you!
about the author
Audrey is the Editor for the HealthTree Foundation for Multiple Myeloma. She joined the HealthTree Foundation in 2020 originally as the Myeloma Community Program Director. While not knowing much about myeloma initially, she worked hard to educate herself, empathize and learn from others' experiences. She loves this job. Audrey is passionate about serving others, loves learning, and enjoys iced chais from Dutch Bros. She loves spending time with her supportive husband and energetic three-year-old.