What should a myeloma patient consider when choosing a treatment option?

What should a myeloma patient consider when choosing a treatment option?

You know, I think a fundamental thing for patients is to know themselves as best that they can. And what I mean by that is to really think about what one's goals are. And it could be quite different for different people depending on their age, their experience with healthcare, their willingness to tolerate toxicities from treatment. All of those things come into play.

So going into it, it's sort of important for an individual to think about what do I prioritize for myself? What am I willing to sacrifice, to, let's say, get a deeper response to therapy? And even beyond that, what can I live with? And what I mean by that is there are some treatments that might knock the myeloma to undetectable, and there are other treatments that might knock it down to control, but not undetectable. But it could be there at a low level for years and years.

Some people can live with that and say it's fine. Other people can't sleep at night unless they have something that's not detectable. Even though the reality is both of those two things might amount to the same. You know, consequence in either any other situation, a patient can go on with their life and function fine. But some people feel like, I'm not happy if there's some level detectable and I can knock it down further, that's a conversation to be had with their doctor.

I've told some patients in that situation, okay, we can modify your therapy and others. I'm worried that if we modify your therapy, we're going to cause you more toxicity just to treat a number. So when thinking. So knowing oneself is critically important, knowing what options are out there, the toxicities of those treatments, the potential benefits. And then there is a requirement of sort of acceptance of, of the unknown because there are situations we just don't know what the right course is.

It is actually a reason, we spoke about earlier, about second opinions to get multiple opinions because, you might hear different perspectives on what to and what to prioritize. But at the end of the day, I think that for an individual, you need to collect as much information as possible, find a physician, and team who you trust and can partner with and feel comfortable and confident about what they're advising you. And then also to kind of know yourself and trust your gut.

But collection gathering is important. And understanding, the ramifications of a decision, what the result is, if you choose treatment A versus treatment B as best you can, what does that mean for you in terms of your quality of life? If you get a treatment, that means you have to come in once a week versus something that you get once, and then you don't have to have any treatment for a long period of time.

For some people, that might be very important. For other people, they might live across the road from the infusion center and say, oh, I can come in once a week if it's less toxicity, I'm going to do that. So trying to piece that all together, I think can be very helpful. And also not second guessing yourself too much because I walk the goal of myeloma therapy until we can cure our goal is to cure myeloma.

Until we are reliably curing myeloma, the next best thing we can do is keep people around long enough so it's not the myeloma that kills them. I mean, because everybody has to go from something and let it not be the myeloma. And we're at a point where that is happening quite frequently. that's not the ultimate goal. But we're getting to that point.

It at least right now, if someone is living their life able to do things and function and go on trips with their family and do the things they love to do, whatever it might be, but they're constantly worried about whether they made the right decision for the treatment they're getting. And there's hand-wringing, then that's not really in their service to anyone, certainly not to them.

So I think the best thing one can do is make a choice, start a therapy, know that you can change course if you're having side effects or problem. I think people often forget that and think, oh, once I commit, I commit. No, once you commit, you only commit. As long as you want to keep taking that therapy, you can make a change in the treatment.

So I think it's okay not to, you know, be awake at night lying there thinking about Jesus. Did I make the right choice or did I not? I think it's important to have the confidence of saying, I've put together a plan. I spoke with my doctors. I got as much information as I can. There probably are still some unknowns here, that nobody's going to be able to give me the answer and I'm going to move forward.

And if it doesn't work, I'm going to make a change with support. Over the last 20 years, look at how many drugs have gotten approved. But because of those options, we have numerous, those treatments. We have numerous options to pick from. And it can be overwhelming for a patient to decide. Do I go with regimen X or do I go with regimen Y?

And your oncologist can play a role in sort of guiding you why they think X, Y, and Z is better than than ABC. However, I take into account several factors. I look at the cytogenetics of the disease. How aggressive is it? Because that makes me, you know, choose a certain regimen.

I look at the rate of progression. So is it just a biochemical response? Biochemical progression is when there's just everything else is fine. There's no lytic lesions. There's no need, nothing popping up. However, you just have a slow increase in your, spike or light change over time, over a long period of time.

Then you may not need a big gun treatment at that point. Then you may not need a big gun treatment at that point. I also look at what their co-morbidities are. As well as where they live. What's their financial situation? Can they afford to come into, weekly treatments or twice weekly treatments?

Hopefully twice weekly treatments will go away. But but those factors need to be taken into account. And also where in the relapse journey are you right? Are you is this a second line relapse? Is this a third line relapse. Is this a fourth line relapse. Because different options are available to you at jump at each of those junctures.

Treatment at relapse. This is, an important and big topic, to be honest. We have multiple options that got approved for multiple myeloma. To me, of special interest is the first relapse. I think the first relapse. We already have the diagnosis established.

So it's important to, choose and pick our treatment wisely. It give us advantage over starting chemotherapy for newly diagnosed, for newly diagnosed, most of the time, the diagnosis will be delayed and the treatment will be started. In a rush. First relapse, is very important.

We take our time to design the best treatment for the patient. Factors that, you know, go into deciding which regimen is the most appropriate for our patient. Our patient preference. Now, we have all oral regimens. We have regimens that can be given IV and other that can be given only subcutaneously, so that out of administration is important.

The side effects of the drugs and the preference of the patient in that regard is very important. We have drugs that can cause neuropathies like autism and others that we have to watch the heart like God fills them.

We have multiple generations now of Ahmed's Immunomodulators, so it's important to take those side effects into account. Most of the time, the side effects from the, prior regimens can play a role in selecting the next regimen. Let's say a patient is on lenalidomide maintenance, which is the most common, you know, first relapse kind of scenario.

Based on the how much the patient can tolerate or tolerate. Revlimid. You could move on to family to might, or maybe you could choose something else completely where it's image free regimen because the side effects from lenalidomide were not, you know, acceptable to the patient.

The most other important factor in deciding what treatment to start for the patient, I think it's, an area of unmet need, to be honest, which is the, high risk population. Patients should, keep in mind that, you know, while we celebrate every success, we celebrate every step and myeloma treatment, achieving a response by itself is, is not the goal for high risk, multiple myeloma.

We can achieve our response. The question or the important, more important point is for how long we can maintain this response. So, picking up regimens for high risk population that are aggressive and can get us a response and not only response, a durable response is very important.

I truly believe, you know, touching base with a myeloma center, is important for those patients specifically. And aggressive chemotherapy is not the answer for all myeloma patients. Some patients with standard risk disease, slow growing, all standard risk, cytogenetics. Early stage.

They might be able to, to, control their disease with, this aggressive approach.