Continuous therapy appears to be the preferred treatment modality in newly diagnosed patients with multiple myeloma (MM), regardless of baseline risk assessment, according to a pooled analysis of 2 phase 3 trials.1 In an article published in Critical Reviews in Oncology/Hematology, Italian researchers reported that patients with a good prognosis who received fixed-duration therapy (FDT) lost their prognostic advantage compared with high-risk patients receiving continuous therapy. In addition, newly diagnosed high-risk patients with multiple may benefit from more intensive maintenance therapy that includes proteasome inhibitors and immunomodulators.
Mattia D’Agostinoa, of the division of hematology at the University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino in Italy, and colleagues conducted a pooled analysis of 2 phase 3 trials (GIMEMA-MM-03-05 and RV-MM-PI-209). These trials included 913 newly diagnosed patients with MM and both had a median follow-up of 4 years. Both trials compared continuous therapy to FDT, which was defined as an upfront treatment (induction/consolidation) for up to 1 year.
The study showed that continuous therapy, which was defined as an upfront treatment (induction/consolidation) followed by maintenance lasting for at least 2 years, increased PFS in R-ISS I patients (hazard ratio [HR], 0.49) and R- ISS II/III patients (HR, 0.55). In addition, the researchers found that high-risk patients benefited more from proteasome inhibitor plus immunomodulatory-based continuous therapy than immunomodulatory alone. The advantage of continuous therapy appeared to be partly related to the use of thalidomide with bortezomib, melphalan, and prednisone during the induction phase in the GIMEMA- MM-03-05 trial.
- D’Agostino M, De Paoli L, Conticello C, et al. Continuous therapy in standard- and high-risk newly-diagnosed multiple myeloma: A pooled analysis of 2 phase III trials. Crit Rev Oncol Hematol. 2018;132:9-16. doi: 10.1016/j.critrevonc.2018.09.008