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Targeted cancer drug treatment

Targeted cancer drugs are treatments that change the way cells work and help the body to control the growth of myeloma. They work by ‘targeting’ the differences that help a cancer cell to survive and grow.

What are targeted cancer drugs?

Cancer cells have changes in their genes (DNA) that make them different from normal cells. These changes mean that they behave differently. Cancer cells can grow faster than normal cells and sometimes spread. Targeted cancer drugs work by ‘targeting’ those differences that a cancer cell has.

Targeted drugs work in different ways. For example, they can:

  • stop cancer cells from dividing and growing
  • encourage the immune system to attack cancer cells
  • stop cancers from growing blood vessels

You might hear some targeted drugs called biological therapies.

There are a number of different targeted drugs you might have, the type you need depends on whether you have had treatment already, your general health and whether you can have a stem cell transplant. You might have a targeted cancer drug alongside other treatments for myeloma, such as steroids and chemotherapy.

Bortezomib (Velcade)

Bortezomib is also known as Velcade. It is a type of cancer treatment drug called a proteasome inhibitor. Proteasomes are in cells. They help to break down proteins that the cell doesn't need. Bortezomib blocks the proteasomes so the proteins build up inside the cell. The cell then dies.   

You have bortezomib either as an injection under your skin (subcutaneously) into your leg or tummy (abdomen). Or as an injection into your bloodstream (intravenously).

You might have bortezomib:

  • before a stem cell transplant - you might have it combined with the biological therapy thalidomide and the steroid dexamethasone (VTD)
  • if you can't have a stem cell transplant or thalidomide - you might have it combined with cyclophosphamide chemotherapy and the steroid dexamethasone (VCD), or combined with melphalan chemotherapy and the steroid prednisolone (VMP)
  • when myeloma first comes back (relapses) - you might have it on its own, or in combination with other drugs
  • as part of a clinical trial to see if it can keep myeloma in remission after successful treatment (maintenance therapy)

Thalidomide

Thalidomide works in different ways. It: 

  • stops cancer cells developing
  • stops cancers making their own blood vessels, that they need to be able to grow
  • stimulates some of the immune system cells to attack myeloma cells

You have thalidomide as capsules. You take them every day, with a glass of water. You should take it before going to bed, as thalidomide can make you sleepy.

Before a stem cell transplant you might have it with:

  • a steroid called dexamethasone and cyclophosphamide chemotherapy (CTD)
  • bortezomib (another type of targeted drug treatment) and dexamethasone (VTD)

If you can't have a stem cell transplant you might have thalidomide with lower doses of chemotherapy (such as cyclophosphamide or melphalan) and a steroid (such as dexamethasone or prednisolone). 

You might also have thalidomide if your myeloma:

  • comes back after treatment (relapsed)
  • other treatments stop working (resistant or refractory)
  • is in remission after chemotherapy treatment (maintenance)

Remission means that there is no sign of active disease in your body.

Daratumumab

Daratumumab is a type of treatment called a monoclonal antibody.  It works by attaching to a protein on the surface of myeloma cells. The protein is called CD38. This helps your immune system to recognise it and kill it.

You might have daratumumab if you have had at least one other treatment and the myeloma has come back. You have it with bortezomib and the steroid dexamethasone. 

Or you might have it on its own if you have had more than three other treatments which 

Lenalidomide (Revlimid)

You might have lenalidomide:

  • if you have already had treatment - you usually have it in combination with the steroid dexamethasone
  • as a first treatment if you can't have a stem cell transplant or thalidomide

Researchers are still finding out exactly how lenalidomide works. It affects all sorts of cell processes, including how cells divide and grow.

We know that it interferes with chemicals that cells use to signal to each other to grow. It affects how the immune system works and is called an immunomodulatory agent. It also stops tumours making their own blood vessels. To develop, all cancers need a blood supply.

Lenalidomide comes as capsules that you take with a glass of water. You need to swallow them whole. Don’t break or chew them. You should take lenalidomide at the same time every day.

Pomalidomide (Imnovid)

Pomalidomide (pronounced pom-a-lid-oh-mide) is a targeted cancer drug and is also known by its brand name, Imnovid.

You might have pomalidomide if you have had at least 2 other treatments which are no longer working, including lenalidomide and bortezomib.

Pomalidomide works in a number of ways, including:

  • stopping the myeloma cells developing
  • stopping blood vessel growth – it is a type of anti angiogenic drug 
  • encouraging the immune system to kill the myeloma cells

You take pomalidomide as capsules with a glass of water. You need to swallow the capsules whole.

Carfilzomib

Carfilozomib is also known by its brand name Kyprolis. Like bortezomib it is a type of proteasome inhibitor. It targets a different part of the proteasome. 

You have it as a drip into your blood stream.

You have it with the steroid dexamethasone. Or you might have it with dexamethsone and lenalidomide.

You might have it if you can't have a stem cell transplant and you have already had another type of treatment which didn't include bortezomib. 

Ixazomib

Ixazomib is also known by its brand name Ninlaro. It is a proteasome inhibitor like bortezomib. You might have this treatment if you can't have a stem cell transplant and you have had at least two other treatments. These treatments must have stopped working or your myeloma has relapsed after you have finished treatment. 

You take it as a tablet once a week for 3 weeks and then have a no treatment for a week. And then you start taking it again. You need to swallow the tablets whole with a glasss of water. and you should not eat for at least an hour before and two hours after taking it. 

Panobinostat

Panobinostat is also known by its brand name Farydak.  Panobinostat is a drug that blocks enzymes called deacetylases (pronounced dee-as-et-isle-azes). Cells need these enzymes to grow and divide. Blocking them can stop myeloma cells growing.

You might have panobinostat if you have had at least two treatments and your myeloma has relapsed. You have it with bortezomib and dexamethasone.

It is a tablet you swallow whole with a glass of water. 

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