Multiple myeloma – a blood cancer involving plasma cells in your bone marrow – can’t be cured. But treatment can keep you healthier and slow down damage to your bones and kidneys. Whether you’ve just been diagnosed, or you’ve had a relapse, you’ll probably be offered a combination of medications known as triplet therapy.
What Is Triplet Therapy?
With this treatment, you’ll take three drugs at the same time. A typical triplet plan includes a corticosteroid, a drug that works on your immune system in general, and a drug that targets your cancer cells specifically.
Your doctor will decide which medicines to try, based on your symptoms, how advanced your multiple myeloma is, and your overall health. They may also test your cancer cells, looking for parts that can be attacked by particular drugs.
The main types of drugs used in triplet therapy are:
Corticosteroids. They help calm your immune system and kill diseased cells. You’ll get them as a pill. The corticosteroids typically used against multiple myeloma are:
Immunomodulators. They manage your immune system to help it fight multiple myeloma. They can keep cancer cells from growing or kill them outright. You take these drugs as a pill. You might get:
Proteasome inhibitors. They allow protein to build up inside cancer cells until it kills them. You get them either as a shot through your skin, an IV into your vein, or a pill. Examples are:
Monoclonal antibodies. They teach your body’s immune system to fight cancer cells. You get them as an IV into your vein. Options include:
- Daratumumab (Darzalex)
- Daratumumab and hyaluronidase-fihj(Darzalax Fastpro)
- Elotuzumab (Empliciti)
- Isatuximab Sarclisa)
You’ll get triplet therapy in 3- or 4-week cycles over several months. You may take one drug every day and the others every few days or once a week. Your doctor will do blood and bone marrow tests to see how the treatment is working.
If a stem cell transplant is part of your multiple myeloma treatment plan, doctors usually recommend having three or six cycles of triplet therapy first. If you’re delaying a transplant until you have a relapse, another five to eight cycles are usually recommended.
If you can’t have a stem cell transplant, the recommendation is eight to 12 cycles of triplet therapy.
Triplet therapy is also usually recommended after you have a relapse, with a different combination of drugs than what you’ve used before. You’ll keep taking it until it stops working.
Is Triplet Therapy Safe?
The addition of the third drug in triplet therapy brings the potential for some serious side effects. Proteasome inhibitors and immunomodulators can cause:
- Fatigue
- Fever
- Problems in your gut like diarrhea and nausea
- Nerve damage called peripheral neuropathy
- Reduced number of blood cells, which can cause anemia, uncontrolled bleeding, or a higher risk of infection
Monoclonal antibodies can cause those same side effects, as well as:
- Allergic reactions
- A higher risk of another cancer
- Respiratory infections
Because of the chances of these side effects, triplet therapy may not be the best choice if you:
- Are over age 75
- Are not active or need help with personal care
- Have certain health problems, including kidney or lung disease
- Have nerve damage
How Well Does Triplet Therapy Work?
Compared to an older program of just a steroid and an immunomodulator, research has shown better results with triplet therapy. More people improve by taking three drugs instead of two, and they go longer without having the disease get worse. In one study, triplet therapy added almost a year to people’s lives.
But triplet therapy isn’t a cure. As with other multiple myeloma treatments, you can expect to have relapses.
