Robert A. Vescio, MD:The patient decided, as mentioned, to continue on lenalidomide and dexamethasone without the proteasome inhibitor. She was followed and felt well. A few years later, her markers for her disease started to increase. Her monoclonal protein went from 0.5 g/dL to 0.7 g/dL to 0.9 g/dL. She felt well. She really didn’t have any complaints, but it was clear that her disease was growing, and so a decision had to be made regarding treatment.
Historically, patients were not always treated when their disease was growing, as determined by tests, if they felt well. We didn’t have drugs that would be well tolerated, and chemotherapy drugs have a bit of a limited life span. They can cause harm when you give them for a long period of time. I personally believe, and I think most data back this up, that if a patient’s disease is growing, even if they feel well, they should be started on treatment to get their cancer back under control.
When you’re deciding whether to start somebody on treatment, particularly when they’re feeling well, I think it is important to be certain that the cancer is growing. A lot of the ways that we follow this disease are through lab tests. There are errors in the testing. Certainly, mistakes can happen in the lab, so in studies and certainly in practice, one should be certain that the markers are getting worse. Usually, in studies, you have to have confirmatory testing to prove that the cancer’s growing back.
Once the monoclonal protein spike has doubled or whatever light chain that their myeloma is making has significantly increased, that’s enough information to embark on treatment.
Transcript edited for clarity.
A 55-year-old African-American Woman With Relapsed Multiple Myeloma
August 2015
May 2018
June 2018
July 2018
Fellow's Perspective: Impact of Quadruplet and MRD in Newly Diagnosed Multiple Myeloma
December 17th 2024In a discussion with Peers & Perspectives in Oncology, fellowship program director Marc J. Braunstein, MD, PhD, FACP, and hematology/oncology fellow Olivia Main, MD, talk about how recent trials shape their approach for a patient with transplant-eligible multiple myeloma.
Read More
Supportive Care Helps Manage AEs With Teclistamab in R/R Multiple Myeloma
December 13th 2024During a Case-Based Roundtable® event, Hana Safah, MD, discussed updated data and adverse event management related to teclistamab in patients with multiple myeloma in the second article of a 2-part series.
Read More