Let’s find out FDA-approved medications for multiple myeloma. Multiple myeloma is a type of blood cancer that affects plasma cells, which are a type of white blood cell that produce antibodies. Multiple myeloma causes abnormal plasma cells to accumulate in the bone marrow and interfere with producing normal blood cells and antibodies. This can lead to various symptoms and complications, such as bone pain, fractures, infections, anemia, kidney damage, and nerve problems.
Multiple myeloma is not curable, but it can be treated with various medications that can slow down the disease progression, reduce symptoms, and improve quality of life. The choice of medication depends on several factors, such as the stage of the disease, the patient’s age, health status, preferences, and response to previous treatments.
This blog will review some of the FDA-approved medications for multiple myeloma and how they work. We will also discuss some common side effects and precautions associated with these medications.
Proteasome Inhibitors: A Class of FDA-Approved Medications for Multiple Myeloma
Proteasome inhibitors is FDA-approved medications for multiple myeloma and are a class of drugs that block the activity of proteasomes, which are enzyme complexes that break down unwanted or damaged proteins in the cells. By inhibiting proteasomes, these drugs cause the accumulation of toxic proteins in the myeloma cells, leading to their death. Proteasome inhibitors also affect normal cells but are more sensitive to the myeloma cells.
What are the types of proteasome inhibitors for multiple myeloma?
- Bortezomib (Velcade): This was the first proteasome inhibitor approved by the FDA in 2003 for treating multiple myeloma. It is given by injection into a vein (intravenously) or under the skin (subcutaneously). It can be used alone or with other drugs for newly diagnosed or relapsed, or refractory multiple myeloma.
- Carfilzomib (Kyprolis): This was approved by the FDA in 2012 for treating relapsed or refractory multiple myeloma. It is given by infusion into a vein (intravenously). It can be used alone or in combination with other drugs.
- Ixazomib (Ninlaro): This was approved by the FDA in 2015 for treating multiple myeloma that has received at least one prior therapy. It is the first oral proteasome inhibitor that can be taken by mouth. It is combined with lenalidomide (Revlimid) and dexamethasone, a steroid drug.
What are the side effects of proteasome inhibitors for multiple myeloma?
- Nausea
- Vomiting
- Diarrhea
- Constipation
- Fatigue
- Low blood counts
- Peripheral neuropathy (nerve damage)
- Increased risk of infections
- Fever
- Rash
- Headache
What are the risks of proteasome inhibitors for multiple myeloma?
- Heart problems
- Lung problems
- Liver problems
- Kidney problems
- Bleeding problems
- Reactivation of herpes virus infections
Proteasome inhibitors may interact with other drugs, so it is important to inform your doctor about all your medications. You should also avoid grapefruit and juice while taking these drugs, as they may affect their absorption and metabolism.
Immunomodulatory Drugs: Another Class of FDA-Approved Medications for Multiple Myeloma
Immunomodulatory drugs in FDA-approved medications for multiple myeloma are a class of drugs that modulate or regulate the immune system. They have various effects on the immune cells and molecules involved in the growth and survival of myeloma cells. They also have anti-inflammatory and anti-angiogenic properties, reducing inflammation and preventing the formation of new blood vessels that feed the myeloma cells.
What are the types of immunomodulatory drugs for multiple myeloma?
- Thalidomide (Thalomid): The first immunomodulatory drug was used to treat multiple myeloma in 1997. It is taken by mouth as a capsule. It can be used alone or with other drugs for newly diagnosed or relapsed, or refractory multiple myeloma.
- Lenalidomide (Revlimid): The FDA approved this in 2006 for treating multiple myeloma. It is taken by mouth as a capsule. It can be used alone or with other drugs for newly diagnosed, maintenance therapy, or relapsed or refractory multiple myeloma.
- Pomalidomide (Pomalyst): The FDA approved this in 2013 for treating multiple myeloma that has received at least two prior therapies, including lenalidomide and a proteasome inhibitor. It is taken by mouth as a capsule. It is used in combination with dexamethasone, a steroid drug.
What are the side effects of immunomodulatory drugs for multiple myeloma?
- Low blood counts
- Fatigue
- Diarrhea
- Constipation
- Nausea
- Vomiting
- Rash
- Dizziness
- Headache
What are the risks of immunomodulatory drugs for multiple myeloma?
- Increased risk of blood clots
- Increased risk of infections
- Increased risk of second cancers
- Liver problems
- Nerve problems
- Birth defects
Immunomodulatory drugs may interact with other drugs, so informing your doctor about all your medications is important. You should also avoid alcohol while taking these drugs, as they may increase the risk of liver damage.
Immunomodulatory drugs can cause severe birth defects or fetal death if taken during pregnancy. Therefore, women of childbearing potential and men who are sexually active with such women must use effective contraception while taking these drugs and for some time after stopping them. Women must also have regular pregnancy tests before, during, and after taking these drugs. These drugs are only available through a restricted program called Risk Evaluation and Mitigation Strategy (REMS).
Monoclonal Antibodies
Monoclonal antibodies in FDA-approved medications for multiple myeloma are a class of drugs made from a single type of immune cell that can recognize and bind to a specific target on the surface of the myeloma cells. By binding to the target, monoclonal antibodies can kill the myeloma cells or recruit other immune cells to destroy them. Monoclonal antibodies can also block the signals that help the myeloma cells grow and survive.
What are the types of monoclonal antibodies for multiple myeloma?
- Daratumumab (Darzalex): This was the first monoclonal antibody approved by the FDA in 2015 for treating multiple myeloma. It targets a protein called CD38, which is highly expressed on the surface of myeloma cells. It is given by infusion into a vein (intravenously) or by injection under the skin (subcutaneously). It can be used alone or with other drugs for newly diagnosed or relapsed, or refractory multiple myeloma.
- Elotuzumab (Empliciti): The FDA approved this in 2015 for treating multiple myeloma that has received one to three prior therapies. It targets a protein called SLAMF7, expressed on the surface of myeloma cells and some immune cells. It is given by infusion into a vein (intravenously). It is combined with lenalidomide (Revlimid) and dexamethasone, a steroid drug.
- Isatuximab (Sarclisa): The FDA approved this in 2020 for treating relapsed or refractory multiple myeloma. It also targets CD38, like daratumumab, but binds to a different protein part. It is given by infusion into a vein (intravenously). It is combined with pomalidomide (Pomalyst) and dexamethasone, a steroid drug.
- Ciltacabtagene autoleucel (Carvykti): This was approved by the FDA in 2022 for the treatment of relapsed or refractory multiple myeloma that has received at least three prior therapies, including an immunomodulatory drug, a proteasome inhibitor, and an anti-CD38 monoclonal antibody. It is a type of cell therapy that uses the patient’s own immune cells that are genetically modified to express a chimeric antigen receptor (CAR) that recognizes BCMA, a protein that is highly expressed on the surface of myeloma cells. The modified immune cells are called CAR T cells and are infused back into the patient’s body to attack and kill the myeloma cells.
What are the side effects of monoclonal antibodies for multiple myeloma?
- Infusion reactions
- Low blood counts
- Fatigue
- Nausea
- Diarrhea
- Constipation
- Fever
- Cough
What are the risks of monoclonal antibodies for multiple myeloma?
- Increased risk of infections
- Allergic reactions
- Heart problems
- Lung problems
- Kidney problems
- Liver problems
- Neurologic problems
Monoclonal antibodies may interact with other drugs, so it is important to inform your doctor about all your medications. You should also avoid live vaccines while taking these drugs, as they may increase the risk of infections.
Other FDA-Approved Medications for Multiple Myeloma
Other FDA-approved medications for multiple myeloma are used to treat multiple myeloma alone or in combination with the abovementioned drugs. Some of these drugs include:
- Alkylating agents: These are chemotherapy drugs that damage the DNA of the cancer cells and prevent them from dividing. Examples of alkylating agents used for multiple myeloma are melphalan (Alkeran, Evomela), cyclophosphamide (Cytoxan), and bendamustine (Treanda).
- Corticosteroids: These are drugs that reduce inflammation and suppress the immune system. They also have anti-myeloma effects by inducing the myeloma cells’ apoptosis (cell death). Examples of corticosteroids used for multiple myeloma are dexamethasone, prednisone, and methylprednisolone.
- Bisphosphonates: These drugs prevent bone loss and reduce the risk of bone complications, such as fractures, pain, and hypercalcemia (high calcium levels in the blood). They work by inhibiting the activity of osteoclasts, which are cells that break down bone tissue. Examples of bisphosphonates used for multiple myeloma are pamidronate (Aredia), zoledronic acid (Zometa), and denosumab (Xgeva).
- Histone deacetylase inhibitors: These drugs modify gene expression in the cancer cells by affecting how DNA is packaged. They can induce cell cycle arrest, apoptosis, and differentiation of the myeloma cells. Panobinostat is an example of a histone deacetylase inhibitor used for multiple myeloma (Farydak).
- Exportin 1 inhibitors: These drugs block the function of a protein called exportin 1, which transports molecules out of the cell’s nucleus. By inhibiting exportin 1, these drugs can disrupt the survival and growth signals of the myeloma cells. An example of an exportin 1 inhibitor used for multiple myeloma is selinexor (Xpovio).
What are the side effects of other drugs for multiple myeloma?
- Nausea
- Vomiting
- Diarrhea
- Constipation
- Fatigue
- Low blood counts
- Increased risk of infections
- Hair loss
- Mouth sores
- Weight gain
- Mood changes
What are the risks of other drugs for multiple myeloma?
- Heart problems
- Lung problems
- Liver problems
- Kidney problems
- Bleeding problems
- Nerve problems
- Skin problems
These drugs may interact with others, so it is important to inform your doctor about all your medications. You should also follow your doctor’s instructions on taking these drugs, when, and managing their side effects.
Conclusion
Multiple myeloma is a type of blood cancer that affects plasma cells. It can cause symptoms and complications, such as bone pain, fractures, infections, anemia, kidney damage, and nerve problems.
Multiple myeloma is not curable, but it can be treated with various medications that can slow down the disease progression, reduce symptoms, and improve quality of life. The choice of medication depends on several factors, such as the stage of the disease, the patient’s age, health status, preferences, and response to previous treatments.
Some of the FDA-approved medications for multiple myeloma include proteasome inhibitors, immunomodulatory drugs, monoclonal antibodies, alkylating agents, corticosteroids, bisphosphonates, histone deacetylase inhibitors, and exportin 1 inhibitors. These medications have different mechanisms of action and different side effects and precautions.
