The more recent study found that “the clinical benefits of the KRd triplet regimen, compared with the Rd doublet regimen, are associated with significant improvements in GHS/QoL, and there was no evidence of a detrimental impact from the triplet regimen on other aspects of HR-QoL.”3

In a podcast accompanying the online edition of the journal, Dr Ola Landgren of the Memorial Sloan Kettering Cancer Center in New York, New York, said the study’s focus on how a patient lives with cancer treatment, as opposed to simply for how long a patient lives, is itself noteworthy. “The bulk of the myeloma literature is focusing on efficacy and drug safety,” he said. “As we move into the future with modern drug combinations, patients with multiple myeloma will continue to live longer and longer. As a consequence, as clinical researchers and treating physicians, we will have to increase our focus on quality of life.”4


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He’s hardly alone.

In a 2015 study, authors Ann Kristin Kvam and Anders Waage remark that “although prolongation of overall survival will always be a main goal of cancer treatment,” physicians need to keep in mind that patients undergo a variety of disease-related effects and that treatments may cause problematic side effects and functional impairments.5

While assessing treatments solely on their effect on quality of life is not yet the standard, Dr Ravi Vij of the Washington University School of Medicine in St. Louis, Missouri, said by telephone that QoL is gaining importance, especially in an age of “value-based care.” Just this past May, the American Society of Clinical Oncology added quality of life into its framework for determining the relative value of therapies.

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“Often issues are being raised about the cost-effectiveness of treatments, which sometimes provide marginal benefits in terms of hard endpoints,” he said. “But if you can layer in quality-of-life, it often will be something that may justify a treatment cost, despite its marginal, sometimes, hard-core data.”

References

  1. Stewart AK, Dimopoulous MA, Masszi T, et al. Health-related quality of life results from the open-label randomized, phase III ASPIRE trial evaluating carfilzomib, lenalidomide, and dexamethasone versus lenalidomide and dexamethasone in patients with relapsed multiple myeloma. J Clin Oncol. 2016 Sep 6. doi: 10.1200/JCO.2016.66.9648 [Epub ahead of print]
  2. Drug combo improves quality of life in multiple myeloma patients. Cancer Network website. http://www.cancernetwork.com/asco-2014-hematology/drug-combo-improves-quality-life-multiple-myeloma-patients. Updated June 4, 2014. Accessed September 2016.
  3. Delforge M, Minuk L, Eisenmann JC, et al. Health-related quality-of-life in patients with newly diagnosed multiple myeloma in the FIRST trial: lenalidomide plus low-dose dexamethasone versus melphalan, prednisone, thalidomide. Haematologica. 2015;100(6):826-33. doi: 10.3324/haematol.2014.120121
  4. Health-related quality of life: increasingly important in the era of effective, modern myeloma therapy [podcast.] J Clin Oncol. 2016 Sep 6.
  5. Kvam AK, Waage A. Health-related quality of life in patients with multiple myeloma – does it matter? Haematologica. 2015; 100(6): 704-5. doi: 10.3324/haematol.2015.127860