A New Look at an Old Standby

I have been feeling a bit vindicated lately. For some time I have lobbied against the use of Revlimid as a maintenance therapy, especially in cases where no Myeloma symptoms were displayed. Revlimid is known for a high incidence of DVT, or blood clots, in addition to heightened Peripheral Neuropathy and a hint at secondary cancers appearing through its use. Celgene recently retracted its application to have Revlimid certified as a primary agent in new Multiple Myeloma cases in Europe. The reason was the tight linkage between Revlimid and secondary malignancies, which are appearing in Revlimid users.

It seems to me that the concept of maintenance drugs stands on weak legs. Having been raised to believe that drugs would only be used when needed, the idea of taking drugs “just in case” strikes me as not being much different than recreational use. My point is, there are a lot of illnesses we might get, so if maintenance drugs are a good idea, we should be taking them against all of the maladies we might contract. What’s good for the goose… The fact that it is called “maintenance” is merely a shill, there is no difference between saying “maintenance” and saying “just in case.” While there are medications which we take to ward off potential threats, like childhood inoculations and boosters, for the most part taking medication where there is no clear and present threat is a foolhardy endeavor.

There is a lot of evidence against the idea of maintenance therapy. There is the continuing deterioration of the body systems from the drugs, there is the tolerance factor of drugs becoming less effective over time, there is unneeded expense, and, in the case of Revlimid, we have secondary cancers appearing in significant enough numbers as to question the value of Revlimid for any except profound cases. While it isn’t spoken to directly, Thalidomide is also implicated in the new perspective. Lenalidomide is an analog, a modification based on Thalidomide which calls into question all of the drugs in the descendant line.

It has taken some time for the concerns against Revlimid to reach the proportions they have. It’s like Giraffe logic. That’s where a sensation in the foot takes a few minutes to register on the brain –far distant atop a very long neck. News of secondary cancers isnt all that new. What was merely observations on the part of patient communities took a while to gain the notice of researching agencies, which then had to expend time to collate information into results. But the situation now appears that Revlimid shouldn’t be embraced the way it has been. Patients need to focus their hopes on Bortezomib and its analogs, and on the emerging drugs currently being vetted.

But it’s also a wakeup call to take a good look at the state of Myeloma treatment regimens. As it is, there is no consistent methodology. The thing is, we know what tools we have available and so there should be a system of diagnosis and treatment that follows a specific protocol, rather than the patient to patient approach we currently use. That’s not to say that one size fits all, on the contrary, the protocol should tailor the medical approach to each patient, but according to science over gut feeling. There is enough information that a standardized protocol of fitting a treatment to a patient should be accomplished, and in doing, afford greater effectiveness while minimizing the side effects of the chosen treatment.

Revlimid is widely used. It is likely that patients themselves, in spite of the clear warnings, want to continue with their treatment. Patients should be the final authority when it comes to their treatment, but perhaps the choices they have should be curtailed by limiting the available choices. I would like to think that doctors might recommend against Revlimid, even in spite of patient preference, considering their first duty is to do no harm. The jury is in and Revlimid has problems. But just as American patients have gone offshore to avail themselves of treatments not available in the US, I suspect that there will be those who continue to use Revlimid, even at their own peril.