Multiple Myeloma: Chemotherapy and Targeted Therapy
What are chemotherapy and targeted therapy?
Chemotherapy (chemo) uses anticancer medicines to kill cancer cells. The medicines are made to attack and kill cancer cells, which grow quickly. Some normal cells also grow quickly. Because of this, chemo can also harm those cells. This can cause side effects.
Targeted therapy medicines work differently from standard chemo medicines. They target specific parts of cancer cells. They tend to have different side effects from chemo medicines.
When might these medicines be used for multiple myeloma?
Chemo and targeted therapy are typically the main treatment for people with multiple myeloma. These medicines are often used along with immunotherapy medicines. The type of medicines you get will depend mainly on these factors:
How quickly the myeloma is likely to grow and cause problems
Whether or not you might be eligible for a stem cell transplant
The goal of treatment
Your age and general health
Concerns you have about side effects
What treatments you’ve had in the past
Your healthcare provider may recommend using one or more of these medicines to treat myeloma in these situations:
As the initial treatment of your myeloma
As part of a stem cell transplant
As a later treatment if the first treatment is no longer working or if the myeloma starts growing again
How are these medicines given for multiple myeloma?
Before treatment starts, you’ll meet with a medical oncologist. This is a doctor who specializes in treating cancer with medicines. These include chemo and targeted therapy. The doctor will talk about your treatment options with you and explain what to expect.
Depending on the specific medicines you’re taking, you may get them in one of these ways:
Intravenous (IV). You’ll receive the medicine through a small needle that’s been put into a vein. The medicine may drip in slowly over several hours, or you may receive it more quickly over a few minutes.
Subcutaneous (subQ). You’ll receive this medicine as an injection under your skin.
Oral. You swallow these medicines as pills.
Chemo and targeted therapy medicines are normally given in an outpatient setting. That means that you get them at a hospital, clinic, or healthcare provider's office. Then you can go home after treatment. Less often, you may need to stay in the hospital during treatment. Your healthcare provider will watch you for reactions during your treatments. Since each of your treatments may last for a while, you may want to take something that’s comforting to you, such as music to listen to. You may also want to bring something to keep you busy, such as a book or mobile device.
To reduce the damage to healthy cells and to give them a chance to recover, you’ll receive these medicines in cycles. Each cycle consists of one or more days of treatment, followed by some time to rest. In general, cycles last three or four weeks. Your healthcare provider will discuss your treatment schedule with you.
Which medicines are used to treat multiple myeloma?
Standard chemo medicines
Chemo medicines are not used as often as they were in the past for the initial treatment of myeloma. But they can still be useful in some situations. These are some common chemo medicines used to treat myeloma:
Targeted therapy medicines
There are several types of targeted therapy medicines to treat multiple myeloma.
Proteasome inhibitors: These include bortezomib, carfilzomib, and ixazomib. These medicines target enzymes in cells called proteasomes.
Histone deacetylase (HDAC) inhibitors. Panobinostat is a medicine that affects histones. These are proteins that affect which genes a cell uses.
Corticosteroids such as dexamethasone or prednisone are often an important part of the treatment for multiple myeloma.
Combining different types of medicines
Many different combinations of medicines can be used to treat multiple myeloma. For instance, some common initial regimens for myeloma include:
Bortezomib and dexamethasone
Bortezomib, doxorubicin, and dexamethasone
Bortezomib, lenalidomide (an immunomodulating drug), and dexamethasone
Bortezomib, cyclophosphamide, and dexamethasone
What are common side effects of these medicines?
Side effects of chemotherapy medicines
Side effects of chemo medicines are different for everyone. They vary based on the medicines you receive. Below is a list of the some of the most common side effects of chemo medicines. Ask your healthcare provider for details about the side effects for the medicines you are getting.
If you have hair loss, the hair will often grow back after the treatment stops.
Nausea and vomiting
This side effect can often be controlled with medicines. Ask your healthcare provider about it.
Chemo can sometimes cause mouth sores. This might make it hard for you to eat or swallow. It's important to keep your mouth very clean and avoid foods and substances that could irritate your mouth.
If you have diarrhea, take antidiarrheal medicines as prescribed by your healthcare provider. You may also need to make changes in your diet.
Loss of appetite or changes in the way things taste
Talk to your healthcare provider if you find you’re having trouble eating or are losing weight. There are often ways to help.
Increased risk of infection
During your chemo treatments, your white blood cell count may become low. This means your immune system won’t be working as well as it normally does. It’s a good idea for you to avoid people who have illnesses that you could catch. It’s also a good idea to take extra safety measures against cuts and scrapes that could become infected. Your healthcare provider will check your blood counts regularly during your treatment. Let your healthcare provider know if you have any signs of an infection. Symptoms include fever, sore throat, a new cough, or burning during urination.
Bleeding and bruising more easily
Chemo can also lower your blood platelet counts. Platelets are needed to help the blood clot well.
You may feel tired while getting chemo. This normally goes away once treatment ends.
Side effects of other medicines
Proteasome inhibitor side effects can include:
Nausea and vomiting
Diarrhea or constipation
Loss of appetite
Low blood cell counts, especially low platelet counts. This can increase your risk of bleeding and bruising.
Nerve damage. This can lead to numbness, tingling, or pain in your hands and feet.
HDAC inhibitor side effects can include:
Tiredness or weakness
Nausea and vomiting
Loss of appetite
Swelling in your arms or legs
Corticosteroid side effects can include:
High blood sugar levels
Feeling like you have too much energy
Working with your healthcare provider
It's important to know which medicines you're taking. Write your medicines down, and ask your healthcare team how they work and what side effects they might have.
Talk with your healthcare providers about what signs to look for and when to call them. For example, chemotherapy can make you more likely to get infections. Make sure you know what number to call with questions. Is there a different number for evenings and weekends?
It may be helpful to keep a diary of your side effects. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage your side effects.
March 21, 2017
Selection of Initial Chemotherapy for Symptomatic Multiple Myeloma. UpToDate.
Alteri, Rick, MD,Gersten, Todd, MD