Understanding Induction Therapy
- If you have just been diagnosed with multiple myeloma, the first round of drugs your doctor prescribes is called induction therapy.
- Induction therapy involves a combination of drugs to send patients into remission. Those drug combinations are commonly referred to as VRD or KRD. Sometimes, a fourth drug is thrown into the mix in order to achieve deeper remissions.
- Dr. Dickran Kazandjian says that the term "induction therapy" may not be the best way to describe this course of treatment. For patients who are not eligible for a stem cell transplant, the drugs used in the induction therapy phase are used again when the patient relapses.
Induction therapy involves a combination of drugs to send patients into remission. Those drug combinations are commonly referred to as VRD or KRD.
Read More- Bortezomib (brand name: Velcade), a proteasome inhibitor drug
- Lenalidomide (brand name: Revlimid), an immunotherapy drug
- Dexamethasone (brand names include: Ozurdex, Maxidex and DexPak 6 Day), a steroid
- Carfilzomib (brand name: Kyprolis), another proteasome inhibitor drug.
- Lenalidomide
- Dexamethasone
RELATED: Is the Three-drug or Four-drug Combo for Induction Therapy Better?
Typically, the induction phase lasts between four and six cycles. Dr. Kazandjian says that in his practice, he gives between eight to 10 cycles in order to achieve the "deepest response" possible. The drug combination is typically given for up to six cycles but can last longer during consolidation therapy.
The Term 'Induction Therapy' for Multiple Myeloma
Dr. Kazandjian says that the term "induction therapy" may not be the best way to describe this course of treatment; it is a "bad nomenclature."
This is because these drugs (mentioned above) are not only given when a patient is first diagnosed with multiple myeloma; this rings especially true for patients who are not eligible for a stem cell transplant.
Multiple myeloma, cancer of the plasma cells, is an incurable cancer, meaning patients never truly rid the disease from their bodies. Instead, patients go into remission, which means the disease is undetectable. But, it is still there, and it will come back.
For patients who are not eligible for a transplant even patients who are eligible but opt against it the drugs used in the induction therapy phase are used again when the patient relapses; sometimes for even longer than the induction phase.
For these transplant-ineligible patients, this is called consolidation therapy, which means the continuation of first-line therapy for about two to four cycles. It is then given again before maintenance therapy.
RELATED: How to Tell if Induction Therapy is Working?
"Historically, induction is meant really to be a part of treatment that, at least in leukemia, that reduces most of the tumor down, and then consolidation is kind of to finish off potentially in residual (disease)," Dr. Kazandjian says. "This nomenclature business gets confusing in myeloma because then sometimes people consider the (stem cell) transplant as consolidation with the high-dose therapy."
"And sometimes people consider consolidation therapy to be a couple of rounds of the same three drugs you got up front, but after transplant as consolidation. … They are all the same doses and frequencies; (there is) nothing special about what we call it," he adds. "Probably the only nomenclature that makes sense is maintenance therapy."
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