Survival Benefits of Maintenance Therapies for Multiple Myeloma
Posted: Tuesday, October 30, 2018
Lenalidomide maintenance therapy appears to be the most effective regimen for patients with newly diagnosed multiple myeloma, according to a meta-analysis of treatment options in the past 20 years published in JAMA Oncology. Francesca Gay, MD, PhD, of The University of Torino, Italy, and colleagues suggested that progression-free and overall survival benefits were greater for patients treated with lenalidomide compared with those who received thalidomide and bortezomib.
Following searches of PubMed and Cochrane databases, the authors identified the records of 5,073 patients who received 8 different treatments among 11 trials. Studies compared at least two maintenance therapies, which included lenalidomide, bortezomib, or thalidomide, with either placebo or no maintenance therapy.
Lenalidomide/prednisone and lenalidomide monotherapy improved progression-free survival by 61% and 53% respectively, compared with placebo or no maintenance therapy. Although thalidomide- and bortezomib-based regimens also improved progression-free survival compared with placebo, the survival benefits were less than those associated with lenalidomide-based therapies. When analyzed for overall survival, patients treated with lenalidomide alone achieved the best results, with an improvement of 24%. The best results in overall survival were followed by those treated with bortezomib/thalidomide and bortezomib/prednisone.
In addition to survival benefits, treatment with lenalidomide carried other advantages. The long-term use of lenalidomide was not limited by neuropathy, a toxicity that substantially limits the long-term use of thalidomide and bortezomib.