Many different drugs are used to treat multiple myeloma and each works against the cancer in a different way. Your cancer team will choose your treatment carefully, personalized for you.
Standard first-line multi-drug therapy
If you are newly diagnosed with multiple myeloma — or now need to begin treatment for your multiple myeloma — the first line of treatment will likely be a combination of three to four different types of drugs, called triplet or quadruplet therapy. This multi-drug combination typically includes a drug from three or four of following categories:
- Proteasome inhibitors. These drugs work to stop enzymes in your cells from breaking down certain proteins that are important to control how cells divide and multiply. Some examples include bortezomib, carfilzomib and ixazomib.
- Immunomodulatory drugs. These oral drugs help boost your immune system against the cancer cells. Your doctor may choose lenalidomide, thalidomide, pomalidomide or another immune modulating drug.
- Corticosteroids. These steroid type drugs, such as prednisone or dexamethasone, reduce inflammation in the body and can have an anti-cancer effect to myeloma cells.
- Monoclonal antibodies. Your immune system makes antibodies to fight off infections. Man-made versions of these, called monoclonal antibodies, are designed to attach to a specific target, such as a protein on the cancer cell. Some monoclonal antibodies for myeloma include daratumumab, isatuximab and elotuzumab.
- Bi-specific T-cell engagers (BiTEs). These newer types of antibodies are made to attach to two targets, one on the cancer cells and one on your T cells (an important kind of immune cell in our body). This action brings the cancer cells and T cells together so the T cells can recognize and attack the cancer cells.
Other drugs for multiple myeloma
Your care team may choose other types of drug treatment for you if you did not achieve remission from your first-line treatment or if one of the drugs stopped working. Other options may include:
- Nuclear export inhibitor. These drugs work against myeloma by using a protein called XPO1 to “steal” or export important proteins from the nucleus of the cancer cell to other parts of the cell. Without these proteins, the myeloma cell dies.
- Chemotherapy. Traditional chemotherapy is not used as often as previously for patients with multiple myeloma as newer drugs have proven more effective. However, it may still be a part of your treatment plan. High-dose chemotherapy may be used to wipe out your bone marrow that’s creating abnormal plasma cells, after which you’ll receive a fresh batch of stem cells to refurbish you bone marrow, a process called a stem cell transplant.