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Forum Name: Multiple Myeloma

Question: New drugs for myeloma


 ravi0273 - Sun Nov 09, 2003 12:01 am

dear gordon,the other day i was going thru jco where i came across proteosome inhibitors for myeloma relapsed.the other one of course thalidomide.any response from ur side regarding this new drugs. :?:
 Dr. Jeffrey Gordon - Fri Nov 14, 2003 2:21 pm

Thalidomide and the proteosome inhibitor (Velcade or bortezomib) are very interesting drugs. Chemotherapy has remained standard therapies for myeloma, but not every patient responds and since a complete eradication of the disease without the use of a bone marrow or stem cell transplantation cannot be achieved, the myeloma at some time after treatment will grow again and become active.

Thalidomide each day is being used by itself or with high-doses of dexamethasone (40 mg) once a week. I do use low doses of thalidomide (200 mg at bedtime each day) with dexamethasone in relapsed myeloma for patients who are not going for a transplantation. Since most myeloma patients are elderly, transplantation is not an option. Thalidomide can work well for extended periods of time. It can cause constipation, sedation, and peripheral sensory neuropathy. But at low doses at bedtime, these side effects are not severe and can be managed. The high dose of the dexamethasone can cause GI side effects and there appears to be an increased incidence of venous thromboses when it is added to the thalidomide. There is still some debate about this. I do not routinely anticoagulate my patients with warfarin (some people recommend it), but I do watch closely for blood clots. I do have my patients take a full strength aspirin.

Bortezomib does have interesting activity in the thrid-line treatment setting of myeloma. It is easy to give and is tolerated well.

There are many exciting studies looking at using thalidomide either with standard chemotherapy or dexamethasone as first-line treatment of myeloma. Bortezomib is also being actively studied early in the course of the disease. Overall, thalidomide and bortezomib have improved our ability to treat patients with multiple myeloma and it will be most exciting to see what develops with clinical research studies using these drugs.

Jeff Gordon, M.D.

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