Three and Four-Drug Combinations for Induction Therapy
- Induction therapy is the first phase of treatment for multiple myeloma. It involves high doses of chemotherapy to put the disease into remission.
- Sometimes induction therapy can involve a three-drug combination, but four-drug combinations can also be used.
- The controversy surrounding which combination is best comes down to the different side-effect profiles. In the near future, experts expect there will be more data available to help determine which induction therapy regimen is best for a particular patient.
Dr. C. Ola Landgren, Leader of Experimental Therapeutics Program & Leader of Myeloma Service at Sylvester Comprehensive Cancer Center at the University of Miami, discusses how treatment decisions are made when choosing among various regimens that involve three-drug or four-drug combinations.
Read MoreThree-Drug Combination
The most common three-drug combination used for induction therapy for patients who are otherwise healthy includes:
Proteasome inhibitor
- Velcade (bortezomib)
- Kyprolis (carfilzomib)
Immunomodulatory drug
- Revlimid (lenalidomide)
Steroids
- Dexamethasone
Four-Drug Combination
Sometimes, a fourth drug is added to the three-drug regimen. Common four-drug combinations for induction therapy include:
Monoclonal antibodies
- Darzalex (daratumumab)
Determining Whether Three or Four-Drug Combination Is Best
So, how do you determine which induction therapy regimen is best?
“There is some controversy in the field,” Dr. Landgren explains. “There are combinations that are FDA approved. There are combinations that are also approved by the National Comprehensive Council Central Network (NCCN) that regulates what is reimbursed or not in the United States.”
RELATED: How Do I Receive Induction Therapy?
Dr. Landgren recognizes that much of the controversy around which combination is best comes down to the different side effect profiles. “The use of the antibodies has very limited additional toxicity and emerging data shows that more patients are reaching a deeper response,” explains Dr. Landgren.
“Preliminary data suggest that the disease control probably lasts longer by adding the antibody.” According to Dr. Landgrem, many multiple myeloma experts are predicting an emerging trend towards four-drug combinations, particularly for newly diagnosed patients who are otherwise healthy.
Much of the decision-making process comes down to considerations of quality of life. A common concern about four-drug combinations is the extra toxicity that they may bring. Each additional drug added to your treatment regimen increases the risk of additional adverse effects.
It’s up to your oncology team to determine whether the benefits of longer disease control outweigh the concerns about side effects.
The Future of Treatment
It’s expected that in the near future, there will be more data available to help determine which induction therapy regimen is best for a particular patient. Currently, there are several clinical trials in progress that will help answer some of the unknowns, including whether four-drug combinations are more beneficial than three-drug combinations for newly diagnosed patients.
While multiple myeloma isn’t curable, new therapies are quickly evolving and improving the outlook for patients. With the help of your medical team, you can work together to choose the induction therapy regimen that offers the best chance for remission and long-term disease control.
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