However, many patients with myeloma aren’t eligible for a stem cell transplant, including those older than 65 or 70.
“At least 50 percent of patients with newly diagnosed myeloma are considered transplant-ineligible,” said Dr. Thierry Facon, the senior researcher on the second study.
In Europe, patients who can’t have a transplant usually receive a particular triple-drug combination, said Facon, a hematologist at University Hospital of Lille in France.
To see whether lenalidomide plus an anti-inflammatory drug — dexamethasone — might work better, they recruited more than 1,600 transplant-ineligible myeloma patients. One-third were randomly assigned to 72 weeks of a standard drug combo (melphalan, prednisone and thalidomide); another third took lenalidomide/dexamethasone over 72 weeks; and the final third kept taking the drug duo until their cancer progressed.
Overall, the study found, patients fared best with continuous lenalidomide. They typically went more than 25 months with no cancer progression versus around 21 months with the other two treatments.
Their longer-term outlook was also brighter. At four years, 59 percent were still alive, compared with 56 percent of patients who received lenalidomide for only 72 weeks, and 51 percent of those given the standard drug regimen.
Facon said that lenalidomide is not formally approved as a first-choice treatment for patients who can’t have a transplant. But he said U.S. doctors can, and do, use it that way. The findings will have a greater impact in other countries, he said.
Avigan agreed that “it’s standard” for U.S. patients who can’t have a transplant to take lenalidomide. But doctors “go back-and-forth” on whether continuous therapy or a finite number of treatments is better, he said.
These new findings suggest that continuous therapy may be a bit more effective, Avigan said. “But the differences aren’t immense,” he added.
Patients on ongoing therapy had more infections than those on shorter-term lenalidomide, Avigan said, though that was the only extra risk seen.
Facon said he’s not yet convinced that continuous lenalidomide is actually better than a finite course, and more study is needed.
Both new studies received funds from Revlimid maker Celgene.
There’s Hope For Myeloma Patients Who Can’t Have Transplant was originally published on blackdoctor.org