How Corticosteroids (Like Dexamethasone) Work to Fight Myeloma
Corticosteroids, like dexamethasone and prednisone, are staple drugs that pretty much every myeloma warrior takes, has taken, or will take. They are the drugs that patients love to hate. They can give make us hyper crazy with energy, neurotic and quick to anger. It can mess with blood sugar levels and once the dose is complete, it can make us "crash." So why can't we just stop taking dex and move onto something else? It's simple. It works well alone and in combination with other myeloma drugs. So how do they work and why are they used in myeloma? Here's a little more about this important class of drugs:
What type of drug is dex? (Answer: it's a corticosteroid)
Dexamethasone is a corticosteroid that prevents the release of substances in the body that cause inflammation. Dexamethasone is used to treat many different inflammatory conditions such as allergic disorders, skin conditions, ulcerative colitis, arthritis, lupus, psoriasis, or breathing disorders. And, yes, multiple myeloma. Source: Drugs.com
More on corticosteroids
Corticosteroids, such as dexamethasone and prednisone, are an important part of the treatment of multiple myeloma. They can be used alone or combined with other drugs as a part of treatment. Corticosteroids are also used to help decrease the nausea and vomiting that chemo may cause. Common side effects of these drugs include
When used for a long time, corticosteroids also suppress the immune system. This leads to an increased risk of serious infections. They can also weaken bones. (Source: cancer.org)
- High blood sugar
- Increased appetite and weight gain
- Problems sleeping
- Changes in mood (some people become irritable or “hyper”)
How it works. From Every Day Health:
Although the body makes steroids in the adrenal glands, which are small glands located on top of your kidneys, dexamethasone is a synthetic (man-made) product created in the laboratory. Dexamethasone may be used alone or in combination with other drugs at any point in the course of myeloma treatment, including during chemotherapy, before a stem cell transplant, and after myeloma has come back, or in a myeloma that has not responded to other therapies.
Myeloma Treatment and Dex
Dexamethasone and the other steroids are useful in myeloma treatment because they can stop white blood cells from traveling to areas where cancerous myeloma cells are causing damage. This decreases the amount of swelling or inflammation in those areas and relieves associated pain and pressure. More importantly, in high doses, dexamethasone can actually kill myeloma cells. When combined with other myeloma drugs, it can also make those drugs work even better. Other agents used with dexamethasone include chemotherapeutic drugs, such as vincristine (Oncovin) and doxorubicin, and immunomodulators (drugs that affect the immune system, the body's natural defenses), such as thalidomide and lenalidomide (Revlimid). Dexamethasone and other steroids are sometimes used by themselves to treat the disease. Dexamethasone is the most effective single agent for treatment of multiple myeloma when given in large doses. The risk of side effects is much higher at these doses, however.
So here are some common drug combos used to treat myeloma. Notice how many of then include dex:
- Melphalan and prednisone (MP), with or without thalidomide or bortezomib
- Vincristine, doxorubicin (Adriamycin), and dexamethasone (called VAD)
- Thalidomide (or lenalidomide) and dexamethasone
- Bortezomib, doxorubicin, and dexamethasone
- Bortezomib, dexamethasone, and thalidomide (or lenalidomide)
- Liposomal doxorubicin, vincristine, dexamethasone
- Carfilzomib, lenalidomide, and dexamethasone
- Dexamethasone, cyclophosphamide, etoposide, and cisplatin (called DCEP)
- Dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophosphamide, and etoposide (called DT-PACE), with or without bortezomib
- Panobinostat, bortezomib, and dexamethasone
- Ixazomib, lenalidomide, and dexamethasone
- Elotuzumab, lenalidomide, and dexamethasone
The choice and dose of drug therapy depend on many factors, including the stage of the cancer and the age and kidney function of the patient.
More on those lovely dex side effects (the list is long and not fun):
- Upset stomach/stomach irritation/vomiting - My advice? Food is your friend. Refrain from taking dex on an empty stomach
- Insomnia: Don't be shy about taking Ambien or another sleep aid. We are already heroes for fighting this disease, no need to push it beyond that
- Restlessness: When I'm on dex, I'm kind of a monster. Yoga, meditation, exercise, and hot baths help calm the soul. And so does Ambien-induced rest
- Depression/anxiety: If you are suffering from severe depression or anxiety, seek help! Our journey isn't easy. If you feel that you need emotional support, let your doctor know right away. Be a hero another time
- Increased hair growth: I wish the hair on my head was growing back faster. The rest? Well, I wax and shave often. And if I miss a spot, so what?
- Easy bruising: I'm black and blue in all kinds of scary places
- Irregular or absent menstrual periods
- Skin rash: Tell your doctor immediately if you develop any kind of rash
- Swollen face, lower legs, or ankles - Again, you must tell your doctor if you experience this one
- Vision problems - That's me! I wear reading glasses on top of my head pretty much all the time. Since I can't keep track of any of them for long, I buy them in large quantities at the Dollar Store
- Cold or infections that last a long time
- Muscle weakness - The only way I know around this one is to exercise. Keep moving. Life weights. Do what you can, it all helps
- Black or tarry stool
Bottom line: You must keep your doctor informed of your health, concerns, and potential side-effects of any drug you're taking. Do not be lax on this one. Yes, it matters! And an ode to Dex via song...
...And now onto something "lighter" and fun (if that can be said with Dex in the same sentence) Jenny Ahlstrom, myeloma survivor, mom, wife, founder of this web site, and so much more, wrote a song about the drug we love to hate. You'll love it! Click here to listen.
The words, so you can sing along, follow:
Don’t be unkind, why be so cruel What did I do to deserve to play the fool? You lift me up, and then let go You’re playing games with me, for all I know And I will get by after all that we’ve been through The real me is trapped inside until I’m free of you And I will say goodbye, when it’s time Waiting for the day that you’re not on my mind After all is said and done, I know I’ll be just fine And I will say goodbye when it’s time I’m in a rage, I want to cry Must think this crazy pain is worth my while I want to go, I always stay I’m running round in circles, can’t go on this way But I will survive after all you put me through Friends wonder why and ask just what I see in you And I will say goodbye, when it’s time Waiting for the day that you’re not on my mind After all is said and done, I know I’ll be just fine And I will say goodbye when it’s time And I will survive after all you put me through The real me is trapped inside until I’m free of you And I will say goodbye, when it’s time Waiting for the day that you’re not on my mind After all is said and done, I know I’ll be just fine And I will say goodbye when it’s time And I will say goodbye, when it’s time Can’t wait for the day that you’re not on my mind After all you put me through, I know I’ll be just fine And I will say goodbye when it’s time