Multiple myeloma chemotherapy drugs

Drugs in chemotherapy and what is chemotherapy?

Chemotherapy is the treatment with potent drugs aimed at the removal of bone marrow mielomatosas cells. Chemotherapy works damaging cells and thus avoiding divide and reproduce.

The drugs used in chemotherapy attack the body cells that divide rapidly such as myeloma cells, but can also affect other body cells that divide quickly such as bone marrow, hair follicles and oral and gastric mucosal.

This means that, unfortunately, chemotherapy can have side effects. The type of chemotherapy prescribed for each patient’s myeloma depends on the individual case and whatever is most appropriate for the individual and for the treatment of the disease at any one time.

What chemotherapy treatments available?

When you start a treatment for active myeloma, the first decision to be taken is the plan or not a stem cell transplant or if this paragraph as a future option.
The treatment regimen most common when planning a future transplant is the combination of drugs known as VAD or those like VAMP, C-VAD or C-VAMP. These combinations include drugs for oral administration and others of intravenous administration. Each of the letters of the earlier combinations represents a different drug, in the case of the VAD, for example, represent the Adriamycin, vincristine, dexamethasone. This regime is often offered to younger patients, but it unfortunately tends to a greater number of side effects.

The combinations of drugs of the type of melphalan and prednisolone and cyclophosphamide are used if a subsequent transplant is not expected. The advantages of the latter group is that drugs can be taken orally instead of intravenous and generally have fewer side effects than the previous ones.

There are new combinations, sometimes within clinical studies, which incorporate thalidomide and VELCADE ® and that can be administered in both groups of patients.

There are other less common types of chemotherapy that include combinations of ESHAP and DT-PACE can be used in certain individual cases in which previous combinations may be contraindicated.

In the following table you can find a list of standard chemotherapies and new combinations used in the treatment of myeloma.

combined treatment advantages disadvantages
VADVincristina
Adriamicina
Dexametasona
  • Responds by 70%
  • Does not damage the stem cells
  • They are the basis for stem cell transplantation
  • Symptoms of active disease can be controlled with faster and the quality of the first remission is often best
  • Intravenous administration requires a way central (catheter)
  • Vincristine may cause neurological damage
C-VADCyclophosphamide
Vincristine
ADRIAMYCIN
Dexamethasone
C-VAMPCyclophosphamide
Vincristine
ADRIAMYCIN
Methylprednisone
Only
DEXAMETHASONE
  • Oral administration
  • It is thought that it provides a high percentage of the benefits obtained with the combination VAD
  • It can be poorly tolerated in intensive treatments
MPMefalan Prednisolone
  • Oral administration
  • Well tolerated
  • Answers by 50%
  • Well known Protocol
  • Damage in stem cells by reducing the chances of collection if a subsequent transplant is planned
C – weekly
Cyclophosphamide
  • Oral administration
  • Does not damage the stem cells
ABCMADRIAMYCIN
BCNU
Cyclophosphamide
Melphalan
  • Combined administration: intravenous and oral
  • It can produce damage in stem cells
CTDcyclophosphamide
Thalidomide
Dexamethasone
  • Oral administration
  • Does not damage the stem cells
  • Responds by 70%
  • Potential effects of Thalidomide secondary: thrombosis and neurological complications
TDThalidomide
Dexamethasone
PAD *VELCADE ®
ADRIAMYCIN
Dexamethasone
  • Does not damage the stem cells
  • Intravenous administration
  • You need several visits to the hospital
  • Potential side effects of the Velcade: neurological complications
VDVELCADE ®
Dexamethasone
MPTMelphalan
Prednisolone
Thalidomide
  • Oral administration
  • Damage in stem cells by reducing the possibilities of collection if a subsequent transplant is planned
  • Side effects of Thalidomide

* The original name of Velcade ® was PS341