Week 176 of chemo complete: My 3 options when I need to change treatment

In March my Myeloma Specialist/Hematologist provided me with 3 options, should we need to change my chemo. My current treatment is Pomalyst + Ninlaro, which are chemo pills. At the time, my cancer levels (m-protein) had been stable for the previous 3 months at 13. Last month my cancer levels spiked from 20 to 25.

This knowledge was very much appreciated as it allowed me to leisurely think about the advantages and disadvantages of each, without pressure. I feel better prepared and confident that when necessary, I’ll make the right decision – in consultation with my Myeloma Specialist.

Option 1: Velcade (high-dose chemo injections) + Cyclophosphamide (chemo pills) + low dose Dexamethasone (steroid pills)

Advantages:
Back in 2013, I had 9 months of treatment followed by 8 months of complete remission, meaning my myeloma was undetectable. So Velcade had previous success.

Disadvantages:
Velcade excited the myeloma cells in the bone marrow of my t7 vertebrae causing immense pain as it slowly collapsed. Although Velcade shortened my height, I feel fortunate not to be paralyzed.

Treatment Setting: Hospital

Option 2: Pomalyst (chemo pills) + low dose Dexamethasone (steroid pills)

Advantages:
This was my treatment from Feb 2015 – July 2017. I believe this combination is likely to lower my cancer levels and keep them low and stable, because that is what was happening before we stopped Dexamethasone.

Disadvantages:
Recall that I was on Dexamethasone with my current Pomalyst treatment from Feb 2015 until July 2017. My Myeloma Specialist stopped it after my Glaucoma Specialist found that Dexamethasone increased my eye pressure. I was prescribed eye drops, which have kept my eye pressure normal, however the Dexamethasone caused right eye damage. As my eyes are steroid sensitive to Dexamethasone, renewing this treatment could result in further eye damage. I would have to find an Ophthalmologist to monitor my eye pressure monthly.

Treatment Setting: Home

Option 3: Pomalyst (chemo pills) + Darzalex (high dose IV targeted treatment)

Advantages:
I would remain on Pomalyst, which doesn’t seem to have any major side effects for me. Combined treatment may be more effective that just Pomalyst or Darzalex alone. As targeted treatment (this is a monoclonal antibody), Darzalex attaches directly to my myeloma cells to kill them and/or allow my immune system to destroy them. This option would be an opportunity to try something new and different.

Disadvantages:
It is unknown what side effects I may experience and there are always general concerns with any IV treatment.

Treatment setting: Hospital

Everything is going to be alright. When I think positive, positive things will happen.

Photo:
These fruit represent my 3 treatment options. The Granny Smith apple is Option 1. It is a common fruit that I’ve had before. I know what I’m getting and what it tastes like. Similarly I know what Velcade + Dexamethasone treatment will be like and the side effects I should experience.

The navel orange symbolizes Option 2. I’ve eaten navel oranges before and know how they taste. Comparably, I know what to expect from Pomalyst + Dexamethasone treatment and the side effects likely to occur.

Option 3 is the Asian pear (front). I have never had an Asian pear before so eating one would be something novel. It is a different colour and shape from what I’d expect a pear to look like. Likewise, Darzalex would be a new experience for treating my multiple myeloma.

Week 176 of chemo complete: My 3 options when treatment change needed

To recap: On Sunday, June 24th, I completed Cycle 44 Week 4. I have multiple myeloma and anemia, a rare cancer of the immune system. Multiple myeloma affects the plasma cells, a type of immune cell that produces antibodies to fight infection. These plasma cells are found in the bone marrow. As a blood cancer, it is incurable, but treatable. Since February 9th 2015, I have been on Pomalyst and Dexamethasone chemo treatment (Pom/Dex). On July 16th 2017, my Dexamethasone treatment ended, due to eye damage, reported by my Glaucoma Specialist, from long-term use. On January 9th I began Ninlaro chemo to combat steadily rising cancer levels.

Weekly chemo-inspired self-portraits can be viewed in my flickr album.

No lawn to mowMay 2014: Coal Harbour – Vancouver

About tyfn

From December 2019 I've been on Darzalex (daratumumab) IV chemo with Velcade (Bortezomib) injection chemo + dexamethasone. Have Multiple Myeloma + anemia, a rare incurable cancer of the immune system. Life goal: To spread awareness about Multiple Myeloma through my self-portraits. UBC MSc Grad.
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