Chemotherapy and other drugs for multiple myeloma
Chemotherapy (chemo) is the use of drugs to kill or control the cancer cells. These drugs are either taken by mouth as a pill or given into a vein or a muscle. The drugs enter the blood and reach throughout the body. This treatment is useful for cancers such as multiple myeloma that often spreads widely. To learn more about chemo for multiple myeloma, please see the chemotherapy section in our document Multiple Myeloma.
Chemo side effects
Chemo drugs kill cancer cells but also can damage normal cells. These side effects depend on the type and dose of drugs given and the length of time they are taken. Common side effects of chemo include:
- Hair loss
- Mouth sores
- Loss of appetite
- Nausea, and vomiting
- Low blood counts
Chemo often leads to low blood counts, which can cause:
- Greater chance of infection (low white blood cell counts)
- Easy bruising or bleeding (low blood platelets)
- Fatigue and anemia (low red blood cells).
Most side effects are temporary and go away after treatment is finished.
If you have side effects, your cancer care team can suggest steps to ease them. For instance, drugs can be given along with the chemo to prevent or reduce nausea and vomiting.
Some chemo drugs can also permanently damage certain organs such as the heart or kidneys. The risks of using these drugs are carefully balanced against their benefits. The doctor will watch these organs during treatment. If damage occurs, the drug that caused it is stopped and replaced with another.
Chemo drugs can be used alone or along with other drugs, like those listed below.
Other drugs used to treat multiple myeloma
These drugs are an important part of the treatment of multiple myeloma and can be used alone or combined with other drugs. They also help decrease the nausea and vomiting caused by chemo. These drugs have short term side effects like high blood sugar, increased appetite, and problems sleeping. They can also weaken the immune system while you are taking them. This leads to an increased risk of serious infections. If taken for a long time, corticosteroids can cause the bones to become weak.
The corticosteroids most often used in treating multiple myeloma are dexamethasone and prednisone.
There are 3 immunomodulating agents (drugs that affect a person’s immune system in unclear ways) used to treat multiple myeloma:
- Thalidomide (Thalomid)
- Lenalidomide (Revlimid)
- Pomalidomide (Pomalyst)
Because these drugs can cause birth defects if taken during pregnancy, they are only available through a special program run by the drug company that makes them.
Side effects of these drugs can include low blood counts, painful nerve damage, and an increased risk of serious blood clots that start in the leg and can travel to the lungs. Each of these drugs can have its own side effects, so ask your doctor about what to expect.
These drugs work by stopping enzyme complexes (proteasomes) in cells from breaking down proteins that help keep cell division under control. Some of these drugs can be used to treat multiple myeloma:
- Bortezomib (Velcade)
- Carfilzomib (Kyprolis)
- Ixazomib (Ninlaro)
Some common side effects of these drugs include nausea and vomiting, tiredness, diarrhea, low blood counts, and fever. Some other, more serious side effects can also occur. Bortezomib and ixazomib can also cause nerve damage that can lead to numbness, tingling, or even pain in the arms and legs. Each of these drugs can have its own side effects, so ask your doctor about what to expect.
Histone deacetylase (HDAC) inhibitors
Panobinostat (Farydak) is an HDAC inhibitor, a drug that can alter which genes are active inside cells by affecting proteins called histones. This drug is taken as a capsule, typically several times a week.
Common side effects include diarrhea (which can be severe), feeling tired, nausea, vomiting, loss of appetite, swelling in the arms or legs, fever, and weakness. This drug can also affect blood cell counts and the levels of certain minerals in the blood. Less common but more serious side effects can include bleeding inside the body, liver damage, and changes in heart rhythm, which can sometimes be life threatening.
Man-made versions of immune proteins, called monoclonal antibodies, can be made to attack a specific target, such as a substance on the surface of myeloma cells. Examples that can be used to treat multiple myeloma include:
- Daratumumab (Darzalex)
- Elotuzumab (Empliciti)
These drugs are given as an infusion into a vein (IV). They are used mainly in people who have already had other drug treatments.
These drugs can cause reactions in some people during or soon after they are given, which can sometimes be severe. Symptoms can include fever, chills, coughing, wheezing, trouble breathing, tightness in the throat, a runny or stuffy nose, feeling dizzy or lightheaded, headache, rash, and nausea.
Other side effects are also possible. These depend on the specific drug.
Interferon is a hormone-like substance made by some white blood cells. When given as a drug, it can slow the growth of myeloma cells. In people who have been treated with other drugs that put the myeloma in remission, interferon is sometimes used to try to prolong the remission.
This drug can cause side effects that include fatigue and other symptoms similar to the flu. Some people find this treatment hard to take.
The choice and dose of the drugs depend on many things, such as:
Last Medical Review: 05/22/2014
Last Revised: 01/19/2016