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Discussion about multiple myeloma treatments, stem cell transplants, clinical trials, alternative medicines, supplements, and their benefits and side effects.

Revlimid v Velcade/Dex/Cytoxan)

by laetetia on Wed Jul 27, 2011 10:49 pm

My partner had a stem cell transplant (own cells) in 2001 and has basically been off the medication since until recently as his paraprotein levels had risen to 14.2 again and his other levels were showing signs of worsening - especially the free kappa took a leap. He has taken thalidomide for 6 weeks but was starting to suffer PN in his fingers and toes so has now stopped. The doctor now has given him a choice of starting either Revlimid on its own or the Velcade with dex and cyclophoshamide. The later he said he'd have to be on for six months. I've been reading through the side effects on the beacon posts and we aren't sure which way to go. Looks like the Revlimid is something long term whereas the other option, after six months he might be able to stop medications again for a few years if all goes well. He's a musician though on top of his full time job and from the sounds of the Velcade, over 50% of people seem to suffer PN.

The doctor said thalidomide was 40% effective, Revlimid 60% and the vel/dex/cycl 88% effective.

Is it possible to take Revlimid and then swap onto the other treatment at a later date if its not working or does taking one mean you can't take the other any more ?

Also, we are in Sydney Australia. His doctor says he has to take the Velcade via IV. Does anyone know if the sq Velcade is available as an option in Australia.

laetetia
Who do you know with myeloma?: De facto
When were you/they diagnosed?: 2001
Age at diagnosis: 53

Re: Revlimid v Velcade/Dex/Cytoxan)

by NSTEWART on Thu Jul 28, 2011 7:38 am

From what I understand you can be on one drug, switch to another if needed, add another, etc. There all kinds of combinations of all of the drugs that are used with people. I was on Revlimid for 8 months prior to my ASCT and haven't been on anything since then. I had relatively few side effects from the drug. The first month I felt nauseated and had some cramping in my hands. After that the nausea went away, but I developed cycles of cramping in my legs at night. As far as I can tell I didn't experience any PN. People go on and off drugs all of the time taking drug holidays. There are a number of oncologists who feel that once your m-protein and FLC numbers are normal that you don't need to take the drugs all of the time.

Do your research as to what is available in Australia and know your options. Then, you and your partner make the decision as to what kind of treatment he decides to pursue.

Nancy

NSTEWART
Name: Nancy Stewart
Who do you know with myeloma?: self
When were you/they diagnosed?: 3/08
Age at diagnosis: 60

Re: Revlimid v Velcade/Dex/Cytoxan)

by Dr. Edward Libby on Thu Jul 28, 2011 7:35 pm

When myeloma is relapsing or progressing I would generally recommend the most effective treatments. He really did well with the transplant which suggests that he will respond nicely this time. If Velcade is not given subcutaneously it should be given once per week ( the original recommendations were for twice a week). The risk of neuropathy falls signifcantly with once per week IV Velcade.
If you search the Beacon for "subcutaneous" you will see that at the recent International Myeloma Workshop in Paris Dr Vincent Rajkumar of the Mayo Clinic Rochester stated that when treating patients with Velcade he almost always uses subcutaneous Velcade, rather than infused, administered once a week. He feels this method and frequency of administration has shown good efficacy while also reducing the risk of peripheral neuropathy. Of note, Dr Rajkumar is one of the preeminent international experts in myeloma.
We have switched to subcutaneous Velcade for all of our patients at the Fred Hutchinson Cancer Research Center in Seattle.
Dr. Edward Libby
University of Washington & Fred Hutchinson Cancer Research Center

Any advice provided in these postings is based on a very limited amount of information. There is no substitute for the care of your oncologist/hematologist. Therefore, all suggestions should be discussed with your treating physician. None of the comments presented here are meant to replace the evaluation of a patient by a knowledgeable physician.


Dr. Edward Libby
Name: Edward Libby, M.D.
Beacon Medical Advisor

Re: Revlimid v Velcade/Dex/Cytoxan)

by Dr. Edward Libby on Fri Jul 29, 2011 8:20 pm

Regarding of the slow acceptance of subcutaneous Velcade by MDs.......
I would add that doctors are understandably reluctant to "jump" to new therapies that they do not have years of experience with or those that are not approved by the various governing bodies like the FDA. This is a sign of a smart cautious physician. We do not want our doctors (in general) to be the first to jump on an uncertain bandwagon.
Dr. Edward Libby
University of Washington & Fred Hutchinson Cancer Research Center

Any advice provided in these postings is based on a very limited amount of information. There is no substitute for the care of your oncologist/hematologist. Therefore, all suggestions should be discussed with your treating physician. None of the comments presented here are meant to replace the evaluation of a patient by a knowledgeable physician.


Dr. Edward Libby
Name: Edward Libby, M.D.
Beacon Medical Advisor


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