Below is an article from the Cancercompass newsletter referring to comments made by Mayo hematologist S. Vincent Rajkumar, M.D.
Dr. Rajkumar raises the central issue in myeloma treatment today. Should mm patients be trying to cure their myeloma or just control it?
I think it's safe to say that all survivors want to cure their cancer. We all want to completely rid our body of our cancer. But it is important to examine the reality of a myeloma diagnosis.
Upon initial diagnosis, we are all told that myeloma is an incurable cancer. And the word incurable stuns both survivors and caregivers alike. When I was first diagnosed in 1994 I read the book Going for the Cure by Dr. Franchesca Thompson. Dr. Thompson recounted the process of the first peripheral blood stem cell transplant for multiple myeloma. And she was going for the cure! So I thought I would too. Surely modern medicine would figure out a way to cure me.
Dr. Thompson died a few years after her pbsct, my conventional therapies left me with extensive nerve damage and it is a documented fact that the majority of patients do not benefit from conventional drugs:
"Dr Roses, an academic geneticist from Duke University in North Carolina, spoke at a recent scientific meeting in London where he cited figures on how well different classes of drugs work in real patients."
"Therapeutic area: drug efficacy rate in per cent
Oncology: 25%"
http://beating-myeloma.or...
So what is a myeloma survivor to do?! A chemo combo like revlimid/dex in lower doses reportedly has a two year remission rate of over 90% with lower side effect rates than other regimens. The beating-myeloma website is filled with information on the benefit of complementary therapies- curcumin has a documented synergistic effect with velcade. Antioxidant supplementation during chemotherapy may increase the benefit of the chemo.
Make no mistake- myeloma is an aggressive cancer- I have used every weapon available to control it.
Cure vs. Control
In a related commentary, Mayo hematologist S.
Vincent Rajkumar, M.D., discusses the need to re-
examine the goals of clinical research and treatment
for patients with MM. Given that MM is generally
considered to be incurable, Dr. Rajkumar poses two
important questions about treatment goals:
"Should we treat patients ... with the goal of
potentially curing a subset of patients, recognizing
that the risk of adverse events and effect on
quality of life will be substantial? Or should we
address myeloma as a chronic incurable condition
with the goal of disease control, using the least
toxic regimens, emphasizing a balance between
efficacy and quality of life ...?"
Dr. Rajkumar explains that for decades, this "cure
vs. control" debate was not necessary because it was
assumed that a cure was unattainable. However, since
the 1990s, several new effective combination
treatments have emerged and produced impressive
results. While these advances are encouraging, Dr.
Rajkumar advises that treatment decisions must still
take into account patients' needs, goals and
attitudes toward overall survival vs. quality of
life.
"Although cure is the ultimate goal of our long-term
research, we need more data from randomized trials
before resorting to highly intense therapy that is
more toxic and unlikely to lead to a cure outside
the setting of a clinical trial."
A peer-review journal, Mayo Clinic Proceedings
publishes original articles and reviews dealing with
clinical and laboratory medicine, clinical research,
basic science research and clinical epidemiology.
Mayo Clinic Proceedings is published monthly by Mayo
Foundation for Medical Education and Research as
part of its commitment to the medical education of
physicians. The journal has been published for more
than 80 years and has a circulation of 130,000
nationally and internationally. discusses the need to re-
examine the goals of clinical research and treatment
for patients with MM. Given that MM is generally
considered to be incurable, Dr. Rajkumar poses two
important questions about treatment goals:
"Should we treat patients ... with the goal of
potentially curing a subset of patients, recognizing
that the risk of adverse events and effect on
quality of life will be substantial? Or should we
address myeloma as a chronic incurable condition
with the goal of disease control, using the least
toxic regimens, emphasizing a balance between
efficacy and quality of life ...?"
Dr. Rajkumar explains that for decades, this "cure
vs. control" debate was not necessary because it was
assumed that a cure was unattainable. However, since
the 1990s, several new effective combination
treatments have emerged and produced impressive
results. While these advances are encouraging, Dr.
Rajkumar advises that treatment decisions must still
take into account patients' needs, goals and
attitudes toward overall survival vs. quality of
life.
"Although cure is the ultimate goal of our long-term
research, we need more data from randomized trials
before resorting to highly intense therapy that is
more toxic and unlikely to lead to a cure outside
the setting of a clinical trial."
A peer-review journal, Mayo Clinic Proceedings
publishes original articles and reviews dealing with
clinical and laboratory medicine, clinical research,
basic science research and clinical epidemiology.
Mayo Clinic Proceedings is published monthly by Mayo
Foundation for Medical Education and Research as
part of its commitment to the medical education of
physicians. The journal has been published for more
than 80 years and has a circulation of 130,000
nationally and internationally.