Recent advances in medications for multiple myeloma have increased the quality of life for people living with this disease. The medications used to treat multiple myeloma work in many different ways. Different classes of medication have been designed for specific functions, and they are often combined to make the best treatment plan.

How Medications Work To Treat Multiple Myeloma

Combinations of different medication classes are used to treat multiple myeloma, according to each individual’s case. Overall, the treatment plan works to treat multiple myeloma by:

• Stopping the growth and division of myeloma cells
• Slowing down the growth and development of B cells into cancerous plasma cells
• Interrupting the communication between myeloma cells and the bone marrow
• Inhibiting the signaling molecules (cytokines) of myeloma cells
• Making it easier for immune cells to recognize myeloma cells
• Encouraging immune cells to kill myeloma cells
• Killing myeloma cells indirectly by causing damage to their DNA
• Killing myeloma cells directly

Classes of Medications

New drugs to treat multiple myeloma are continuously being developed, studied, and improved. There are many classes of drugs approved by the U.S. Food and Drug Administration, and more are in clinical trials. Currently, classes of medications include chemotherapy, immunomodulatory drugs, corticosteroids, histone deacetylase (HDAC) inhibitors, monoclonal antibodies, proteasome inhibitors, and bisphosphonates.

Chemotherapy

Chemotherapy is the treatment of cancer with drugs that destroy or slow the growth of cancer cells.

Chemotherapy drugs include:

• Adriamycin (doxorubicin)
• Alkeran (melphalan)
• Cytoxan (cyclophosphamide)
• Doxil (liposomal doxorubicin)
• Pepaxto (melflufen)
• Treanda (bendamustine)
• VP-16 (etoposide)

Chemotherapy drugs can be taken as pills or given intravenously (through a vein). These medications can also affect noncancerous cells and can have major side effects. Therefore, drugs may be used more often than chemo.

Immunomodulatory Drugs

The goal of immunomodulatory drugs is to help activate the immune system against cancer cells.

Immunomodulatory drugs include:

• Pomalyst (pomalidomide)
• Revlimid (lenalidomide)
• Thalomid (thalidomide)

Side effects of immunomodulatory drugs include fatigue, neuropathy (painful damage to nerves), increased risk of blood clots, and low white blood cell counts (which can raise the risk of infection).

Corticosteroids

Decadron (dexamethasone) and Deltasone (prednisone) are examples of corticosteroids, drugs used to decrease inflammation, pain, and pressure. Corticosteroids can also help treat common side effects of chemotherapy such as nausea or vomiting.

Side effects of corticosteroids can include mood changes, sleeping problems, weight gain, and high blood sugar levels. Corticosteroids can also cause immune-system suppression and weakened bones if they’re taken for a long time. These effects can be especially problematic for people living with multiple myeloma, but they tend to go away when you stop treatment with the corticosteroid.

Histone Deacetylase Inhibitors

HDAC inhibitors, such as Farydak (panobinostat), affect the way genes are read and used. The goal of HDAC inhibitors is to kill cancer cells by making their DNA unusable, which stops cell growth and division. Side effects of HDAC inhibitors include fatigue, nausea, vomiting, severe diarrhea, appetite loss, fever, and muscle weakness.

Monoclonal Antibodies

The goal of monoclonal antibodies is to target and attack specific protein markers on myeloma cells. Monoclonal antibody therapies include:

• Darzalex (daratumumab)
• Empliciti (elotuzumab)
• Sarclisa (isatuximab)

Monoclonal antibodies are very effective against a single target, but some side effects and reactions can be serious. For example, during or shortly after treatment, tightness in the throat, wheezing, feeling dizzy, and trouble breathing can occur. If you experience these severe side effects, contact a health care professional immediately.

Less severe side effects can include fatigue, fever, cough, back pain, nausea, and lowered blood cell counts.

Proteasome Inhibitors

A proteasome is an enzyme responsible for breaking down old or unusable proteins in a cell. Defects in the protein-breakdown pathway can lead to many different diseases, including multiple myeloma. When taken long-term, the proteasome inhibitor ixazomib can help lengthen the time of progression-free survival (time during which the cancer doesn’t get worse), even in high-risk people.

Examples of proteasome inhibitors include:

• Kyprolis (carfilzomib)
• Ninlaro (ixazomib)
• Velcade (bortezomib)

Commonly reported side effects include nausea, vomiting, fatigue, fever, low white blood cell counts, diarrhea, constipation, back pain, and easy bruising or bleeding.

Bisphosphonates

Bone-modifying drugs, such as bisphosphonates and Xgeva (denosumab), are not used to kill myeloma cells. Instead, the goal of these drugs is to prevent bone weakening, slow the degradation of bone, and control high levels of calcium in the blood caused by multiple myeloma.

Examples of bisphosphonates include:

• Aredia (pamidronate)
• Bonefos (clodronate)
• Boniva (ibandronate)
• Didronel (etidronate)
• Zometa (zoledronic acid)

Though bisphosphonates lower the risk of fractures and reduce bone pain, they can also cause problems with bone healing. Bisphosphonates and denosumab can increase the risk of developing osteonecrosis of the jaw, a type of dental bone disease, as a side effect. It is common to have a dentist clear a person for the use of these drugs.

Long-Term Treatment of Multiple Myeloma

Many combinations of these drugs are used to treat multiple myeloma. Oncologists will typically tailor multiple myeloma treatments to fit each person. Factors such as age, disease severity, cancer cell genetics, and whether it’s an initial or relapsed disease can influence the treatment plan.

The optimal treatment for each individual's case of multiple myeloma will likely change over time. Ongoing treatment with medication for multiple myeloma can help control the disease and its symptoms and improve other outcomes like survival rate — potentially leading to a better and longer life.

Unfortunately, long-term management of multiple myeloma with drug therapies can lead to complicated side effects. One study reported that people who participated in educational sessions about side effects were better able to manage theirs, compared to people who did not attend these sessions. If you have questions about your medications and their potential side effects, be sure to speak with your doctor or pharmacist.

Talk With Others Who Understand

MyMyelomaTeam is the social network for people living with multiple myeloma and their loved ones. More than 11,700 members come together to ask questions, give advice, and share their stories with others who understand life with myeloma.

Are you living with multiple myeloma? What medications have worked for you? Share your experience in the comments below, or start a conversation by posting on your Activities page.