Such a simple abstract, with so many lessons to learn. Example of how Cytoxan and dex–at low doses–helped a relapsed patient in kidney failure stay stable for almost two years:
Long-term Control in a Patient with Refractory Multiple Myeloma by Oral Cyclophosphamide and Dexamethasone
Background: Prognosis of patients with multiple myeloma (MM) has substantially improved in recent years due to the incorporation of novel drugs into their treatment. However, older drugs should be kept in mind when modern drugs have failed. Case Report: We report on a 62-year-old female patient with high-risk, refractory light-chain myeloma who initially presented with acute renal failure and was consecutively treated with six different therapies without achievement of sustained disease control. Therapy of cyclophosphamide orally at 50 mg/day (100 mg twice a week) and dexamethasone at 24 mg once weekly was initiated, resulting in a very good partial response which was maintained for more than 21 months. Low-dose cyclophosphamide in combination with dexamethasone was well-tolerated and no significant hematological or nonhematological side-effects were noted. Conclusion: We suggest that older drugs should be kept in mind as treatment options for patients with disease refractory to multiple therapies, including novel agents.
This “clinical trial of one” in Europe poses a number of questions. First, they used smaller doses of Cytoxan, spread out over time, instead of once a week 500 mg dosing here in the States. But of more interest to me: 24 mg of dex weekly instead of 40 mg that’s standard here. Does anyone really know what optimum dex dosing is? Does 40 mg weekly dose work best, or is it used because everyone else uses that dose?
To me, Cytoxan is an example of a number of other older therapies that have been discarded by most myeloma specialists. Two other prime examples: melphalan/prednisone and thalidomide. Both work, but as a general rule doctors hate looking back.
Here’s the link to the above abstract:
Moral of this story? Relapsed patients should ask their doctors about the option of using tried and true, older myeloma therapies, possibly mixed in with newer cutting edge drugs like pomalidomide and carfilzomib.
Feel good and keep smiling! Pat