Lenalidomide-Based Maintenance Therapy May Be the Most Effective in Myeloma

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Evidence supporting the overall superiority of a single regimen in the maintenance setting in newly diagnosed multiple myeloma is lacking.
Evidence supporting the overall superiority of a single regimen in the maintenance setting in newly diagnosed multiple myeloma is lacking.

Continuous therapy with lenalidomide may lead to the greatest improvements in survival outcomes among patients with newly diagnosed multiple myeloma (NDMM) compared with other regimens in the maintenance setting, according to a study published in JAMA Oncology.1

Many agents have demonstrated efficacy as maintenance agents in patients with NDMM. Due to a lack of comparative studies, however, evidence supporting the overall superiority of one regimen over another is lacking.

For this meta-analysis, researchers evaluated the outcomes of 11 studies representing 5073 patients with NDMM and 8 different treatment regimens. The maintenance options evaluated were no maintenance/placebo, bortezomib plus prednisone, interferon, lenalidomide alone, lenalidomide plus prednisone, thalidomide alone, thalidomide plus bortezomib, and thalidomide plus interferon.

An analysis of progression-free survival (PFS) showed that lenalidomide-based regimens led to the greater improvements (lenalidomide alone: hazard ratio [HR], 0.39; 95% CI, 0.28-0.53; lenalidomide plus prednisone: HR, 0.47; 95% CI, 0.39-0.55) compared with the other maintenance regimens. Interferon alone was the only regimen that did not show any benefit for PFS in the maintenance setting.

In an analysis for overall survival (OS), lenalidomide alone was found to be the most beneficial regimen (HR, 0.76; 95% CI, 0.51-1.16), followed by thalidomide-bortezomib and bortezomib plus prednisone. No other regimens were observed to improve OS.

Consistent findings were reported in the restricted networks of patients, including patients in transplant trials, in a population of patients not previously exposed to novel agents, and among patients across most of the prognostic subgroups.

Results showed that lenalidomide-based maintenance therapies lead to the best survival outcomes among patients with NDMM. The authors added that better treatment options are still necessary, however, and concluded that drugs such as proteasome inhibitors and immunomodulatory agents, used in combination with maintenance therapies, could offer promising alternative regimens. “These well-tolerated drugs, which could have a potential efficacy in standard but also in high-risk disease, could become available in the maintenance therapy setting in the near future, and increase the treatment options for patients with MM.”

Reference

  1. Gay F, Jackson G, Rosinol L, et al. Maintenance treatment and survival in patients with myeloma [published online August 9, 2018]. JAMA Oncol. doi: 10.1001/jamaoncol.2018.2961

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