MRP-R Not Superior to MPT-T for Newly Diagnosed Myeloma

Lenalidomide plus melphalan and prednisone, followed by lenalidomide maintenance (MPR-R) was not superior to melphalan, prednisone, and thalidomide, followed by thalidomide maintenance (MPT-T) in patients with newly diagnosed multiple myeloma ineligible for stem cell transplantation, a study published in the journal Blood has shown.¹

Although the combination of MPT is considered standard therapy for newly diagnosed patients with multiple myeloma who are not eligible to undergo stem cell transplantation, long-term maintenance treatment with thalidomide is often associated with neurotoxicity. In contrast, MPR-R has shown promising efficacy without causing severe neuropathy.

For the multicenter, open-label, phase 3 trial, researchers enrolled 637 patients and randomly assigned them 1:1 to receive 9 cycles of MPT every 4 weeks followed by thalidomide maintenance until disease progression or unacceptable toxicity or 9 cycles of MPT every 4 weeks followed by lenalidomide maintenance.

Results showed that after a median follow-up of 36 months, progression-free survival was 20 months (95% CI, 18 – 23) with MPT-T compared with 23 months (95% CI,19 – 27) with MPR-R (HR, 0.87; 95% CI, 0.72 – 1.04; P = .12).

Researchers found that response rates between groups were similar, with very good partial responses or better occurring in 47% of the MPT-T group and 45% of the MPR-R group.

In terms of safety, hematological toxicity was reported more frequently with MPR-R, particularly grade 3 and neutropenia, while grade 3 or worse neuropathy was significantly more common with MPT-T. Grade 3 or worse neuropathy resulted in a significantly shorter duration of maintenance therapy, regardless of age.

“MPR-R has no advantage over MPT-T concerning efficacy,” the authors concluded. “The toxicity profile differed with clinically significant neuropathy during thalidomide maintenance versus myelosuppression with MPR.”

Reference

1. Zweegman S, van der Holt B, Mellqvist U-H, et al. Lenalidomide plus melphalan and prednisone, followed by lenalidomide maintenance versus thalidomide plus melphalan and prednisone, followed by thalidomide maintenance; results of the randomised phase 3 HOVON 87/NMSG18 trial [published online ahead of print January 22, 2016].  Blood. doi: 10.1182/blood-2015-11-679415.