Is It Safe to Travel During Myeloma Treatment?

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Topics include: Living Well

In this Patient Power replay, Host Andrew Schorr asks experts Dr. Larry Anderson, Jr. and Dr. Robert Orlowski about how patients can continue to travel during myeloma treatment. Dr. Larry Anderson explains why traveling might be tough for those getting treatment for myeloma and the issue of drug resistance. Dr. Robert Orlowski follows by talking about oral therapies for traveling patients, compliance with those medications, and elaborating on the inconsistencies that could lead to drug resistance.

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Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

Andrew Schorr:

I wanted to ask about this, kind of drug holidays, drug vacations. Let’s say somebody was getting an infused therapy, and they want to take that cruise.

They want to go do something that they’ve wanted to do for a long time. They’re doing pretty well, but otherwise they’re on a maintenance therapy. And maybe it’s infused, or they’re going to the clinic every week for a shot, and they want to go to Europe or wherever. Larry, how do we do that?

Dr. Anderson:    

It’s always a little tough. Certainly if they’re in a good remission, on maintenance therapy, no signs of relapse and they want to go away for a month or two, I'm usually okay with that. It’s usually the problem arises if their markers aren’t exactly stable, and they might be trending toward going up. Then we really feel nervous about taking them off therapy. And we don’t want to generally take them off for more than a month or two at a time because of the possibility of increased level of resistance when they do go back on it. And we don’t really know what effect that might have.

Andrew Schorr:

Okay, and, of course, I'm referring to where you need to go to the clinic, maybe, for the treatment. But I alluded to earlier, Bob, about oral therapy.

So if they’re taking ixazomib (Ninlaro), or you’re going to have some of these—lenalidomide (Revlimid), other oral therapies, that’s sort of under their control. And there’s this word called compliance or adherence, and we’ve seen in some other cancers where people feel good, or, related to the financial toxicity that we talked to earlier, they either cut their pills or skip doses or forget for whatever reason. What do you want to say about this age of oral therapies related to myeloma and the responsibility of the patient to stay on plan? 

Dr. Orlowski:     

First, in terms of vacations, because as you mentioned ixazomib, which is an oral proteasome inhibitor, one thing I’ve done on some patients who want to travel is if they’re doing okay, but they’re on either bortezomib (Velcade) or carfilzomib (Kyprolis), which have to be injected, for a few weeks it’s usually okay either to not do that medication at all or to switch to ixazomib, which they can just pack in their suitcase and take with them.

But you’re right, because compliance is going to be very important here. The medication will not work if it’s not taken, if it’s not taken on the prescribed schedule. It will either not work if it’s taken less often. Or if you take it more often, then it may cause more side effects.

And the bigger issue comes as well from my perspective, if their myeloma, if the numbers start to go upward, we may assume that the patient has been taking the therapy and that the disease is no longer responding to that treatment and prematurely switch them to something else without knowing that maybe that stuff that they’re on is still actually okay. And then you’re using up treatment options that you may not have to, because you want to try to save some things for later.

Andrew Schorr:

Good point. I know for me, I take a daily medicine morning and night.

And I have that little pill box next to my toothbrush, and I am religious. And also, I don’t know if it’s true with the myeloma drugs as it is with my leukemia drug where if you stop taking it, you can have kind of a rebound effect that it could—I don’t know if it applies. In other words, not only are you not getting the benefit of the medicine, but other things can happen. Is that true at all with any of those?

Dr. Orlowski:     

I’m not sure we know of a rebound effect, really.

Andrew Schorr:

Good, okay.

Dr. Orlowski:     

But what Larry mentioned earlier is true about resistance. We do think that if you sort of take a little bit, stop, take a little bit, stop you’re more likely to induce cancer cells that are resistant than if you continuously take the treatment as prescribed.

Andrew Schorr:

And just so we understand resistance, that’s where the cancer cells are finding a way around the drug.

Dr. Orlowski:     

Correct.

Andrew Schorr:

Loss of effectiveness of the drug—you don’t want to play a role in that because you’re sort of a yoyo of what dose you’re taking.

Dr. Orlowski:     

It’s kind of like antibiotics. One of the ways to develop resistant bacteria is if you’re prescribed antibiotics, but you don’t complete the whole course. And you don’t completely kill the bacteria, and they find a way to become resistant. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

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Page last updated on June 2, 2017