Recurrent Multiple Myeloma

Overview

Recurrent multiple myeloma has persisted or returned following treatment initial treatment. About one-quarter of patients with relapsed disease will experience a remission of their cancer after several cycles of chemotherapy. Treatment with newer “targeted” therapies or high-dose therapy followed by a stem cell transplant appears to produce better outcomes.

The following is a general overview of conventional and investigative treatments for recurrent multiple myeloma. Cancer treatment may consist of targeted therapy, high-dose therapy and stem cell transplantation, supportive care, or a combination of these treatment techniques. Combining two or more of these treatment techniques has become an important approach for increasing a patient’s chance of cure and prolonging survival.

In some cases, participation in a clinical trial utilizing new, innovative therapies may provide the most promising treatment. Treatments that may be available through clinical trials are discussed in the section titled Strategies to Improve Treatment.

Circumstances unique to each patient’s situation influence which treatment or treatments are utilized. The potential benefits of combination treatment, participation in a clinical trial, or standard treatment must be carefully balanced with the potential risks. The information on this website is intended to help educate patients about their treatment options and to facilitate a mutual or shared decision-making process with their treating cancer physician.

Targeted Therapy for Recurrent Multiple Myeloma

The introduction of three new drugs for multiple myeloma — Velcade® (bortezomib), Revlimid® (lenalidomide), and Thalomid® (thalidomide) – has improved outcomes among patients with newly-diagnosed multiple myeloma as well as patients with relapsed or refractory multiple myeloma.

Velcade® (bortezomib): Velcade is a targeted therapy that inhibits the activities of a group of proteins, called proteasomes. These proteins are found in virtually all cells, but are particularly important for allowing myeloma cancer cells to survive and grow. By inhibiting the proteasomes, Velcade kills cancer cells and reduced overall cancer growth.

Important support for the use of Velcade in the treatment of relapsed multiple myeloma came from a phase III clinical trial known as the Assessment of Proteasome Inhibition for Extending Remissions (APEX) trial. The study enrolled more than 600 patients with relapsed multiple myeloma. Half the patients were treated with Velcade and half were treated with high-dose dexamethasone. Compared to the patients treated with dexamethasone, patients treated with Velcade had longer time to cancer progression (6.2 months versus 3.5 months), higher response rate (38% versus 18%), and better one-year survival (80% versus 66%). Serious side effects, however, tended to be more common in patients treated with bortezomib than patients treated with dexamethasone[1]

Studies have also evaluated Velcade in combination with other therapies, and several of these combinations have produced promising results.[2] In a phase III clinical trial, the combination of Velcade with pegylated liposomal doxorubicin resulted in longer survival than Velcade alone among patients with relapsed or refractory multiple myeloma.[3] Fifteen-month survival was 76% among patients treated with Velcade plus pegylated liposomal doxorubicin compared to 65% among patients treated with Velcade alone.

Revlimid® (lenalidomide): Revlimid is a derivative of thalidomide which has similar activity but less toxicity.

In a study conducted in the United States and Canada, the addition of Revlimid to dexamethasone has been shown to improve treatment outcomes among patients with relapsed multiple myeloma.[4] Compared to patients treated with dexamethasone alone, patients treated with Revlimid plus dexamethasone experienced a longer time to cancer progression (11.1 months vs. 4.7 months) and better overall survival (29.2 months vs. 20.2 months). The addition of Revlimid to dexamethasone did increase the occurrence of side effects, however, such as neutropenia (low white blood cell counts) and blood clots.

Thalomid® (thalidomide): Thalidomid is a drug that was originally developed as a sleeping pill, but researchers began investigating it as an anticancer drug when they discovered that it slows or stops the growth of new blood vessels. Cancer cells require food and oxygen in order to grow and spread. These essential nutrients are transported to the cancer cells by blood vessels. By inhibiting the growth of new blood vessels, Thalidomid “starves” the cancer of the food and oxygen that it needs to survive and grow.

Thalidomid appears to be an active treatment for relapsed multiple myeloma. Results of a clinical trial indicate that one-third of patients treated with Thalidomid experience an anticancer response, including patients who relapse after stem cell transplantation. The researchers estimated that more than half of the patients survived one year or more after treatment.[5]

Response to treatment may be even greater when Thalomid is combined with other drugs.[6] Thalomid and dexamethasone – a combination that has been shown to be effective in the initial treatment of multiple myeloma – has also shown promise in the treatment of relapsed multiple myeloma, and the addition of other drugs may further increase response rates.

High-dose Therapy and Stem Cell Transplant for Recurrent Multiple Myeloma
Supportive Care: Managing the Side Effects of Myeloma and Treatment
Strategies to Improve Treatment of Multiple Myeloma

CancerConnect Cancer Commuity & Discussions

References


[1] Richardson PG, Sonneveld P, Schuster M et al. Bortezomib or high-dose dexamethasone for relapsed multiple myeloma. New England Journal of Medicine. 2005. 352:2487-98.

[2] Richarson PG, Hideshima T, Mitsiades C, Anderson KC. The emerging role of novel therapies for the treatment of relapsed myeloma. Journal of the National Comprehensive Cancer Network. 2007;5:149-162.

[3] Orlowski RZ, Nagler A, Sonneveld P et al. Randomized phase III study of pegylated liposomal doxorubicin plus bortezomib compared with bortezomib alone in relapsed or refractory multiple myeloma. Journal of Clinical Oncology. 2007;25:3892-3901.

[4] Weber DM, Chen C, Niesvizky R et al. Lenalidomide plus dexamethasone for relapsed multiple myeloma in North America. New England Journal of Medicine. 2007;357:2133-42.

[5] Singhal S, Mehta J, Desikan R et al. Antitumor activity of thalidomide in refractory multiple myeloma. New England Journal of Medicine. 1999;341:1565-1571.

[6] Richardson P, Mitsiades C, Schlossman R et al. The treatment of relapsed and refractory multiple myeloma. Hematology 2007. American Society of Hematology Education Program Book; 317 – 323.