What is Multiple Myeloma:
Plasma cell myeloma also known as multiple myeloma, is a kind of cancer that occurs in plasma cells, a type of white blood cell that normally produces antibodies.
Multiple myeloma drugs are existing in several drug classes, including:
Proteasome Inhibitors (PIs)
Immunomodulatory drugs (IMiDs)
Alkylating Agents
Corticosteroid
Histone Deacetylase Inhibitors (HDACs)
Bisphosphonates
Monoclonal Antibodies (MAbs).
Above mentioned list of multiple myeloma medications is used as a frontline relapse treatment. The elaboration is as follows:
Alkylating Agents:
Melphalan (Alkeran): Melphalan Indicated for use in palliative treatment of Multiple myeloma, approved for use throughout the disease course.
Possible side effects include suppression of blood cell counts, hypersensitivity reactions, infertility, and pulmonary toxicity.
Cyclophosphamide (Cytoxan): Cyclophosphamide indicated for use in the treatment of Multiple myeloma alone or in combination with other agents.
Possible side effects include suppression of blood cell counts, urinary tract and renal toxicity, infections, diarrhea, vomiting, nausea, fever and pulmonary toxicity.
Anthracycline:
Doxorubicin: Doxorubicin hcl indicated for use in combination with bortezomib in patients who have not previously received bortezomib and have received at least one prior therapy.
Possible side effects include hair loss, vomiting, nausea, mouth sore, eye problems, allergic reactions, change in the color of urine, decreased blood cell count, infection, lower sperm count and infusion site reactions.
Corticosteroid:
Dexamethasone (Decadron): Dexamethasone has no specific FDA approval for myeloma, approved for palliative management of leukemias and lymphomas.
Used in almost every regimen for the front line and relapsed multiple myeloma.
Not used in maintenance because of side effects from long term used.
Possible side effects include infection, fluid retention, rash, acne, weight gain, hoarseness, coughing, muscle pain, sleeplessness and elevated blood glucose.
Immunomodulatory Drugs (IMiDs):
Thalidomide (Thalomid): Thalidomide approved to use in combination with dexamethasone for the treatment of newly diagnosed myeloma, but is used throughout the disease course including for maintenance therapy.
possible side effects include dizziness, rash, low white blood cell count, drowsiness and embryo-fetal toxicity.
Lenalidomide (Revlimid): Lenalidomide 25 mg approved to use throughout the disease course, including maintenance therapy.
Possible side effects of lenalidomide could be as embryo-fetal toxicity, low white blood cell counts, low platelet counts, rash, anemia, fatigue, diarrhea and constipation.
Pomalidomide (Pomalyst): Pomalidomide 4 mg approved in order to use in combination with dexamethasone for the treatment of patients with multiple myeloma who have relapsed after at least 2 prior therapies including Revlimid and a proteasome inhibitor.
Possible side effects of pomalidomide 2 mg or 4mg include low white blood cell counts, embryo-fetal toxicity, low red blood cell counts, low platelet counts, dizziness, weakness, fatigue, constipation, confusion, nausea and diarrhea.
Proteasome Inhibitors (PIs):
Bortezomib (Velcade): Bortezomib approved for use as treatment for myeloma and as retreatment for patients who had previously responded to treatment and who have relapsed at least 6 months after completing prior Velcade treatment. Possible side effects include nausea, diarrhea, fatigue, thrombocytopenia, more rarely headache, low blood pressure, insomnia, back pain, fever and muscle cramps.
Carfilzomib (Kyprolis): Carfilzomib indicated as a single agent for patients with multiple myeloma who have received at least 2 prior lines of therapy including bortezomib and an IMiD.
And in combination with lenalidomide and dex for patients with relapsed multiple myeloma who have received 1-3 prior lines of therapy.
Possible side effects include infusion reactions, fatigue, cardiac events, low blood pressure, shortness of breath, fever, diarrhea, anemia and thrombocytopenia.
Monoclonal Antibodies (MAbs):
Daratumumab (Darzalex): Daratumumab indicated for use in combination with Rd or Vd, for multiple myeloma patients who have had at least 1 prior therapy.
In combination with VMP for newly diagnosed non-transplant eligible patients, as monotherapy for patients have had at least 3 prior therapies including a PI and an IMID and or are double refractory to a PI and an IMID.
Possible side effects include low blood cell counts, back pain, fever, cough, fatigue, nausea and infusion reactions.
Histone Deacetylase Inhibitors (HDACs):
Panobinostat (Farydak): Panobinostat medication is approved to used in combination with bortezomib and dex (dexamethasone) for the treatment of multiple myeloma patients who have received at least 2 prior regimens including bortezomib and an IMiD.
Possible side effects include diarrhea, vomiting, nausea, low blood counts, fatigue, infections, hemorrhage, liver toxicity and embryo-fetal toxicity.
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