Targeted Therapy for Multiple Myeloma: What You Should Know

Targeted therapy is just one of several drugs your doctor might give you to treat your multiple myeloma. It's different from chemotherapy and radiation, which kill cancer cells but also damage healthy cells. Targeted therapy goes after genes, proteins, and other substances that help cancer cells grow. It mainly spares healthy cells.

Examples of targeted therapy drugs for multiple myeloma are:

• Proteasome inhibitors. These drugs block certain enzymes the cancer cells need to survive. Examples include bortezomib (Velcade), carfilzomib (Kyprolis), and ixazomib (Ninlaro).
• HDAC inhibitors. Panobinostat (Farydak) targets a protein that allows myeloma cells to grow and spread rapidly.
• Immunomodulating drugs. These drugs work on the immune system, blocking the ability of cancer cells to divide and spread. Examples include lenalidomide (Revlimid), pomalidomide (Pomalyst), and thalidomide (Thalomid).
• Monoclonal antibodies. These drugs attach to and block a substance on the outside of cancer cells that the cancer needs to grow. Examples include daratumumab (Darzalex) and elotuzumab (Empliciti).

Before you start on a targeted therapy medication, here are eight things you should know about this type of treatment.

1. Targeted therapy is only one part of a multifaceted treatment strategy

Although targeted therapy kills cancer on its own, doctors often use it as one part of a complete treatment plan. Even if targeted therapy is the first drug you get, you can have radiation, chemotherapy, a stem cell transplant, or other treatments along with it.

2. Your situation will determine which drug you get

Whether you get targeted therapy and which of these drugs you take depends on factors such as:

• how aggressive your cancer is
• how old you are
• how healthy you are
• which treatments you've already had
• whether you're eligible for a stem cell transplant
• your personal preferences

3. There are two ways to give these drugs

Some targeted therapies come as pills that you take orally at home. If you take the pills at home, make sure you know the correct dose to take and how to store the medication.

Other targeted therapies are available as injections. You'll need to visit your doctor to get the injectable versions through a needle into a vein.

4. Targeted drugs are expensive

Targeted therapy is effective, but it can be expensive. Ninlaro costs about $111,000 per year, while Darzalex is about $120,000.

Health insurance will typically cover at least part of the cost, but each plan is different. Oral versions are often covered under an insurance plan's prescription drug benefit, rather than its cancer chemotherapy benefit. This means you may end up paying more out of pocket for pills than the injectable versions.

Before you start treatment, ask your insurance company how much they'll cover, and how much you'll have to pay out of pocket. If you're responsible for more than you can afford, see if the drug manufacturer offers a prescription drug assistance program to help bridge the cost.

5. These drugs do have side effects

Because targeted therapy doesn't kill healthy cells like chemo does, it won't cause hair loss, nausea, and some other unpleasant side effects of chemotherapy. However, these drugs can still cause side effects.

The side effects you experience depend on the drug and dose you receive, but they can include:

• fatigue
• diarrhea
• constipation
• infections
• stuffed or runny nose
• a burning or pins-and-needles sensation in your arms, legs, hands, or feet from nerve damage (neuropathy)
• shortness of breath
• skin rash

If you have any of these side effects after treatment, ask your doctor if there are treatments you can take to help manage them. Don't stop taking your medication.

6. Expect to see your doctor a lot

You'll see your healthcare team for regular visits during your treatment. At these visits, you'll have a thorough exam, along with blood tests, CT scans, or other imaging tests that assess how you're doing and whether your treatment is working.

7. If at first you don't succeed, try again

Targeted therapy may not work for you on the first try, or it might stop your cancer only temporarily. If you started on a targeted therapy and it stops working, your doctor might try giving you the same drug again, or switch you to another treatment.

8. Targeted therapy won't cure multiple myeloma

Multiple myeloma isn't curable yet, but the outlook is getting better. The introduction of targeted therapies and other new treatments are greatly improving the survival time for people with this cancer.

Takeaway

Targeted therapy is a new approach to treating multiple myeloma. Unlike chemotherapy, which kills both cancer cells and healthy cells, these drugs target certain changes that are specific to cancer cells. This makes it much more precise at treating multiple myeloma.

Before you start on this or any other cancer treatment, make sure you understand what it will do to help you, and what side effects it might cause. If anything is unclear, ask your doctor to explain it in more detail.