Bortezomib

Bortezomib (brand name Velcade) is part of a group of medicines known as proteasome inhibitors. Proteasomes are enzymes found in cells. They help control cell function and growth by controlling the breakdown of important proteins. Bortezomib blocks the activity of proteasomes. This disrupts the growth and survival of cancer cells, especially myeloma cells.

Bortezomib may also improve bone disease in myeloma patients. This improvement can happen whether or not the myeloma responds to bortezomib.

Bortezomib is given as an injection into the bloodstream, either in the veins or under the skin of the thigh or abdomen.

Thalidomide

Thalidomide (brand name Thalomid) is a drug that affects the immune system. Thalidomide increases the immune system's response against myeloma cells. It helps stop the growth and survival of myeloma cells.

Thalidomide is often used in combination with other drugs. It can be used for newly diagnosed patients, whether they are candidates for stem cell transplant or not. It can be used for patients whose myeloma has relapsed. Thalidomide can also be used as maintenance therapy (treatment that is started after remission in order to reduce the risk for relapse).

The combination of thalidomide and dexamethasone (dex), known as Thal-dex, is FDA approved for treating newly diagnosed MM patients. Other treatment combinations include Thal-dex with bortezomib for treatment before transplant, MPT with bortezomib for older individuals, and thalidomide alone or in combination with prednisone, a corticosteroid, for maintenance therapy.

The use of thalidomide must be considered carefully for each patient. Thalidomide is associated with an increased risk of side effects. This risk must be weighed against the potential benefits. Your doctor will determine if thalidomide is the right treatment choice for you.

Lenalidomide

Lenalidomide (brand name Revlimid) is a cancer drug used to treat multiple myeloma. It is taken by mouth.

Lenalidomide is part of a class of drugs called immunomodulatory drugs (IMIDs). IMIDs work against cancer cells by affecting the immune system. Lenalidomide works to slow or kill myeloma cells. It directly affects the tumor cells. It also affects the blood vessels and other substances surrounding a tumor that help feed the cancer cell's growth.

Lenalidomide is chemically related to thalidomide, another IMID, but lenalidomide has been shown to be more potent. It has different side effects than thalidomide. Common side effects of thalidomide such as sleepiness, constipation, and painful nerve problems occur much less frequently with lenalidomide.

Lenalidomide is used in all stages of multiple myeloma. Although it can be used alone, it is usually combined with another anti-myeloma drug, dexamethasone (dex). This combination is called Revlimid-dex. Lenalidomide has also been shown to extend remission time when used as maintenance therapy following high-dose chemotherapy and stem cell transplantation. Lenalidomide is also being studied in combination with other myeloma drugs, such as bortezomib, and new drugs in development.