[anne1Participant]

Does anyone happen to know how the lines of treatment differ from each other and why they’re categorised as first, second etc? I wonder if it’s to do with effectiveness, cost or how long they’ve been used for, or maybe something else I haven’t thought of.

Thanks

Anne

[rabbitParticipant]

Hi Anne,

When someone is diagnosed with myeloma, they are put on treatment. That is the ‘first line’ (typically chemo + stem cell transplant). Assuming that this puts the patient into remission, the remission may well end at some point, and a new, different* treatment is needed. This is the ‘second line’. And so on.

* The nature of myeloma cancer cells is that they can ‘evolve’ and ‘develop resistance’ to medicines, a bit like bacteria developing resistance to an antibiotic. Therefore a new line of treatment is generally different from the previous ones.

Regards
Rabbit

[anne1Participant]

Hi Rabbit

Thanks for your reply. I was wondering why first line treatments are first line, second line second and so on. How are they different from each other and what’s the criteria for grouping them into certain lines of treatment. Heard first line are most effective with fewer side effects but not sure this is the case.

Thanks

Anne

[rabbitParticipant]

Hi Anne,

The combination of drugs given within a line of treatment have been shown to be effective in a clinical trial (unless the patient is actually in a clinical trial).

“Heard first line are most effective with fewer side effects but not sure this is the case.”
That’s broadly right. The effectiveness and side effects can vary unpredictably from one person to another, though.

Also, when a drug is first approved, it may be approved only for the later lines of treatment. Then if more data is accumulated on efficacy and side effects that is favourable, it may be approved for earlier lines of treatment.

Regards
Rabbit

[anne1Participant]

Hi Rabbit

That’s good information and makes sense that newer drugs are further down the lines of treatment. I wonder if that will apply to Cart T and bispecifics when they’re approved, which will be hopefully sooner rather than later.

Thanks for replying

Regards

Anne

[rabbitParticipant]

Hi Anne,

In recent weeks, Elranatamab, a bispecific antibody treatment, has been approved as a fourth line treatment in the UK.

See https://bloodcancer.org.uk/news/new-class-of-drug-approved-for-myeloma/

Regards
Rabbit

[anne1Participant]

Hi Rabbit

Pity Elranatamab is fourth line as being the first bispecific, would have good if it had been bumped up the lines of treatment. Maybe in time it might be.

Thanks for your response.

Anne

[squirrelParticipant]

Hi Rabbit
Do you know the standard lines of treatment?
I had first line lenalidomide and now on second line carfilxomib with cyclophosphamide and not lenalidomide.
Told second line recommendations had changed to this.
Where can you find this information please?

• This reply was modified 3 months, 1 week ago by  squirrel.

[anne1Participant]

The Myleoma U.K. website has the lines of treatment listed under Understanding Myleoma and Treatments. My consultant, however, told me they don’t use lines of treatment like they once did because there are so many new drugs that they can jump from one to another so I assume they must also stick to the protocols too. I’m about to start KRD but that doesn’t rule out having other second line drugs in future, apparently. I’m interested if anyone else has been told about lines of treatment as being not as rigid as before by consultants. (I live in Scotland so drugs have to be approved by Scottish Consortium rather than NICE, as is the case in England and Wales).

Anne

[Author]

Posts