The Myeloma Beacon’s Virginia Li wrote an interesting report late last week, highlighting how “more is not necessarily better” when it comes to myeloma therapy.
Here is the first part of her article:
Among Velcade-Based Combinations, Four-Drug Combo Is Not More Effective Than Similar Three-Drug Combos For Newly Diagnosed Multiple Myeloma
The results of a recent Phase 2 clinical trial comparing four Velcade-based combination therapies in newly diagnosed multiple myeloma patients show that a four-drug combination containing Velcade, Revlimid, cyclophosphamide, and dexamethasone led to similarly high response rates as the three-drug regimens, but resulted in a higher rate of side effects.
“We were hoping to see more activity at the same level of toxicity as the three-drug combination, but the result was similar efficacy at higher toxicity,” said Dr. Shaji Kumar of the Mayo Clinic in Rochester, Minnesota, and lead investigator of the study. “Clearly, as the study showed, more is not necessarily better.”
However, Dr. Kumar added, “I think we should continue to work on novel combinations of drugs working through different mechanisms in order to identify better ways to treat these patients…”
I guess it’s only natural that some myeloma specialists would conclude if a three drug combination therapy works well, a four drug combo might work even better. But in this case, guess it didn’t turn-out that way.
CLICK HERE to read more from last week’s Myeloma Beacon article.
But let’s back-up here a second. To me, this type of approach is akin to using an elephant gun to hunt squirrels.
WHY? For the most part, multiple myeloma is a relatively easy cancer to treat in newly diagnosed patients. Using Revlimid and dex alone, I was able to achieve a deep and complete response (CR) in less than ten months.
Other patients have had similar success using Thalomid or Velcade.
NOTE TO MYELOMA DOCS: Why use everything up front–all at once–when one or two drugs will do the job?
I know, I know. Doctors need to treat high risk patients aggressively. And studies have shown that a combination of Revlimid, Velcade and dex (RVD) works best in all types of newly diagnosed patients. But adding the second drug only increases effectiveness by five or ten percent. Why not treat myeloma incrementally, carefully noting which drugs and doses work best for each individual patient?
If a patient isn’t responding to one drug, try another. Still not the response that was hoped for? Fine. Use them together. But it shouldn’t be a surprise that there would be more side-effects while using four drugs than three or two.
Treating multiple myeloma is a marathon, not a sprint! We need to keep our bodies strong in order to withstand what is quickly becoming a decade or more of treatment.
The same principle applies to stem cell transplants. What’s the hurry, docs?
I’m simply suggesting everyone take a deep breath, step back and save a few bullets to use later in this long, war of attrition. I’m just saying…
Feel good and keep smiling! Pat