Thalidomide- or Lenalidomide-based Maintenance Therapy Improves PFS in Multiple Myeloma

Thalidomide- or lenalidomide-based maintenance therapy improved progression-free survival and overall survival in patients with multiple myeloma, but also increased the risks of grade 3 to 4 adverse events, according to a study published in the Journal of the National Cancer Institute.¹

The treatment of multiple myeloma has progressed dramatically with the introduction of immunomodulatory drugs (IMiDs) and proteasome inhibitors, however it remains incurable. Consolidation and maintenance therapy can possibly improve outcomes. While most trials have shown benefit of IMiD-based maintenance therapy in delaying disease progression, the question of whether it improves survival is unclear.

Therefore, investigators performed a meta-analysis to evaluate the impact of IMiDs on survival outcomes and serious adverse effects in patients with multiple myeloma. Investigators looked at 18 phase 3 randomized controlled trials including 7730 patients.

Results showed that IMiD-based maintenance therapy prolonged progression-free survival (HR, 0.62; 95% CI, 0.57 – 0.67; P < .001) but failed to provide an overall survival benefit (HR = 0.93; 95% CI, 0.85 – 1.01; P = .082).

Stratified analyses showed that thalidomide and lenalidomide provided progression-free survival benefit, but not in overall survival in transplantation and nontransplantation settings.

IMiD-based maintenance therapy was linked with a higher risk of patients developing grade 3 to 4 thromboembolism (risk ratio = 2.52; 95% CI, 1.41 – 4.52; P = .002).

Thalidomide maintenance therapy increased the risk of peripheral neuropathy, while lenalidomide maintenance therapy increased the risks of myelosuppression and second primary hematological malignancies.  

Reference

1. Wang Y, Yang F, Shen Y, et al. Maintenance therapy with immunomodulatory drugs in multiple myeloma: a meta-analysis and systematic review. J Natl Cancer Inst. 2016;108(3):dvj342.