What long term strategies should patients understand?
Sure.
I mean, I think this is, a lot of open questions that need to be answered with really good comparative effectiveness research is what is the right sequence of treatments for patients with myeloma?
How is it that we are going to be able to control this disease as long as possible, while minimizing toxicity?
I think we moved to an era where we know that, multidrug combinations, three drug combinations, maybe four drug combinations really do provide the deeper responses, especially early, and can help keep patients in those responses for a much longer periods of time.
And the trick here is to hit hard and fast, at least in my opinion, and then back down to the least toxic, least invasive, strategy possible to keep that disease in ideally remission as long as possible.
So in my hands this tends to mean, maintenance revlimid, indefinitely.
But again, that's something to sort of discuss with patients, depending on their risk, some of their risk stratification, features at diagnosis.
And then the trick is going to be then to reemploy either similar drugs or different combinations.
But again a combinatorial approach at relapse to again try to hit hard, get the disease under control, and then be able to back down, and sequence drugs to both make the toxicities as tolerable as possible, make administration as tolerable as possible, and keep those responses as durable as possible.
And so you don't want to burn bridges unnecessary early by switching drugs too quickly, but you also want to be able to use, good effective therapy throughout the treatment course that you have a good chance and a really solid hope of it, providing good response and durable responses every time that you need to employ new treatment strategies.
HealthTree • December 13, 2019