There is enormous excitement today regarding a mainstay of multiple myeloma treatment the steroid dexamethasone which has proven to be very beneficial for COVID-19 patients. “Low dose dexamethasone significantly lowers mortality in COVID-19 [patients],” Dr. S. Vincent Rajkumar, MD, a medical oncologist at the Mayo Clinic specializing in multiple myeloma says speaking to the exciting new results. “This is a fantastic [trial].”
According to a statement from the Chief Investigators of the RECOVERY (randomized evaluation of COVID-19 therapy) trial on dexamethason, the low-cost corticosteroid greatly reduced death rates for people on respiratory support. Death rates were decreased by 35% for ventilated patients and 20% for patients on oxygen.
Read MoreDexamethasone and COVID-19
According to Dr. Paul Richardson the Clinical Program Leader and Director of Clinical Research at the Jerome Lipper Multiple Myeloma Center at the Dana-Farber Cancer Institute, “the concept of targeting inflammation and so interrupting the cytokine storm that leads to increased mortality is key in COVID-19.” A cytokine storm is a severe immune reaction in the body that’s common in COVID-19 and that can be deadly. Richardson explains the importance of halting this immune reaction without opening the door to secondary infections and other complications that’s where dexamethasone comes in.“However, more will be needed, in my opinion, to truly defang the severe form of this disease and other treatment options will be vital,” says Richardson.
How Dexamethasone is Used in Myeloma Treatment
Dexamethasone is a corticosteroid which stops white blood cells from traveling to areas where cancerous cells are causing damage, reducing swelling and inflammation, and relieving pain and pressure.
The steroid can be used alone or combined with other myeloma treatments and can also be used to help decrease the nausea and vomiting that chemotherapy may cause.
The First Treatment For Myeloma: “Induction Therapy” with Dexamethasone
For the last several years, most patients newly diagnosed with multiple myeloma have been put on an initial triple-drug regimen, and usually that regimen is a combination called VRd, which consists of these three drugs: Velcade (bortezomib), Revlimid (lenalidomide), and low-dose dexamethasone. This first treatment, also referred to as frontline or induction therapy, is prescribed to patients of all ages and risks, regardless of whether they are considered good candidates for a stem cell transplant. The previous standard regimen was a two-drug regimen which didn't contain bortezomib. The addition of this drug, according to a study published in 2016, gave patients an average additional year of survival.
The newer triple-drug regimen being touted as an alternative frontline therapy for multiple myeloma is called KRd. It's a combination of two of the same drugs that are in VRd: lenalidomide (Revlimid), and dexamethasone . But instead of bortezomib it contains Kyprolis (carfilzomib) as the third drug. Coming into wider use just a few years ago, some doctors initially saw KRd as a new standard of care for multiple myeloma frontline therapy.
But newer doesn't always mean better as new study has shown. The interim analysis found that the median progression-free survival was 34.4 months for VRd and 34.6 months for KRd. And the overall survival was equally close: 84 percent for VRd and 86 percent for KRd. “Any time you want to change practice, you want to have good quality evidence that shows one of those is better than the other,” Dr. Vincent Rajkumar, a multiple myeloma specialist with the Mayo Clinic in Rochester, Minnesota, told Survivornet. “The real question is, was one triplet better than the other? And no, it was not.”
Both triple-drug treatments have their advocates, and both carry risks and benefits. Determining which one to use is important since initial therapy has the greatest impact on patient outcomes. Here's what you need to know about each:
Learn more about SurvivorNet's rigorous medical review process.
