This week’s “Ask Dr. Durie” is in response to several patient questions about the use of maintenance therapy. And the main question is: Can maintenance therapy be tweaked to get the best results? Or is it important just to continue with the initially started dose?
The broad answer is that ongoing tweaking or modifications of maintenance therapy are extremely important to avoid any possible ongoing toxicities and to improve the benefit of the ongoing results with the maintenance treatment.
And so, on the side of side effects or toxicities, it’s common with lenalidomide, Revlimid®, which is used as maintenance, that the dose must be reduced or maybe the schedule, the length of the treatment must be modified because an increasing reduction in blood counts has occurred, perhaps reduction in the white blood cell count or the platelet count.
And so, it’s extremely important to reduce the dose, to modify the schedule so that the Revlimid can be better tolerated. But crucially, so that the maintenance therapy can be continued. Because we know that the benefit with maintenance therapy is a result of continuing with the therapy for as long as possible to get that ongoing benefit.
Now, in terms of getting the optimal results, sometimes if the myeloma protein level is increasing very slightly, it may be optimal to slightly increase the dose of the Revlimid or maybe add in another drug, such as once-a-week dexamethasone, or maybe Ninlaro® which is a proteasome inhibitor, which is taken by mouth. This can be to enhance the response.
And so, the BOTTOM LINE for patients who are concerned about this, is to open an active discussion with your doctor if you’re on maintenance so that you can review; what is the status of the myeloma? How are you doing in terms of side effects? So, that these important tweaks can be made to reduce the dose, or maybe slightly increase the dose, or add another drug in so that you can have ideal results and be able to stay on the maintenance for the optimal recommended length of time to achieve the ideal outcomes.