Targeted (biological) therapies for active myeloma

Targeted therapies are treatments that work by targeting proteins found either on the surface of cancer cells or inside the cells.

Targeted therapies that are used for myeloma are:

  • Thalidomide – Thalidomide can be used to treat newly diagnosed myeloma, or to help control myeloma that has come back (relapsed). It can be given in combination with chemotherapy and steroids. Thalidomide can cause birth defects in developing babies. 
  • Bortezomib – Bortezomib can be given as a first treatment for myeloma or if myeloma comes back. Your doctors may also give it in some situations as treatment to prepare you for a transplant. You may have bortezomib with steroids or chemotherapy.
  • Lenalidomide – Lenalidomide is used when myeloma comes back after other treatment. Sometimes it is offered as part of a trial. Lenalidomide is a capsule that you take once a day for three weeks, followed by one week off. You may continue with this treatment for as long as the myeloma is under control.

What are targeted therapies?

Targeted therapies are treatments that work by targeting proteins that are found either on the surface of cancer cells or inside the cells. Targeted therapies that are used for myeloma are thalidomide, bortezomib and lenalidomide.


Thalidomide

Thalidomide can be used to treat newly diagnosed myeloma, or to help control myeloma that has come back (relapsed). It can be given in combination with chemotherapy drugs and steroids. Thalidomide is taken daily as a tablet, usually in the evening.

It is thought that thalidomide works in a few different ways. These include affecting the body’s immune system and stopping cancer cells from developing new blood vessels. This reduces the cancer cell’s supply of oxygen and nutrients.

Side effects can include:

  • constipation
  • drowsiness
  • an increased risk of developing blood clots in the veins in the legs, called deep vein thrombosis (DVT).

Sometimes thalidomide can damage nerves, which can cause tingling in your hands and feet. This is called peripheral neuropathy. You may notice that you have difficulty fastening buttons or doing similar fiddly tasks. Your hands and feet may also become more sensitive to the cold. If you notice any of these side effects, tell your doctor. The side effects usually disappear slowly after treatment ends, although it can sometimes take months.

Thalidomide can cause birth defects in developing babies. Both men and women taking thalidomide can pass on this risk. You will take part in a pregnancy prevention programme while taking thalidomide. Your doctor will give you information about not becoming pregnant or fathering a child during and after treatment with thalidomide.

Women of childbearing age will have a pregnancy test before starting treatment with thalidomide. They will also have one every four weeks during treatment, and four weeks after treatment finishes.

Your doctor and nurse will help you manage any side effects of thalidomide, but sometimes the side effects outweigh the benefits. The dose of thalidomide may need to be reduced or may occasionally need to be stopped.


Bortezomib (Velcade®)

Some people may have bortezomib as a first treatment for myeloma, or if myeloma comes back. Your doctors may also give it in some situations as treatment to prepare you for a transplant.

Bortezomib is a proteasome inhibitor. It interferes with enzymes (proteasomes) that are found in all cells, including cancer cells. Bortezomib causes cancer cells to die and can stop the cancer from growing.

It is usually given as an injection under the skin (subcutaneously), but it may be given into a vein (intravenously). You may also have treatment with steroids or chemotherapy.

Side effects of bortezomib include:

  • tiredness
  • nausea
  • diarrhoea
  • dizziness
  • numbness or tingling in the hands and feet (peripheral neuropathy)
  • a low number of platelets, which means you bruise or bleed more easily.


Lenalidomide (Revlimid®)

Lenalidomide is used when myeloma comes back after other treatment. Sometimes lenalidomide is offered as part of a trial.

It belongs to a group of drugs called immunomodulatory drugs, which affect the way the immune system works. It also blocks the development of new blood vessels, which cancer cells need to grow and spread.

Lenalidomide is a capsule that you take once a day for three weeks, followed by one week off. You may continue with this treatment for as long as the myeloma is under control. If you are having side effects, sometimes your doctor may adjust the dose.

Side effects of lenalidomide include:

  • a low number of white and red blood cells and platelets
  • diarrhoea
  • constipation
  • skin rashes
  • sleepiness.

If you take lenalidomide with steroids, there is an increased risk of blood clots in your legs. You may be given blood-thinning medicines to reduce this risk.