Access to Care: Thalidomide-Based Therapy in Multiple Myeloma
Posted: Monday, November 19, 2018
In countries without access to proteasome inhibitors or lenalidomide, patients who have recently been diagnosed with multiple myeloma and are eligible for stem cell transplantation may be limited to treatment with traditional cytotoxic drugs. The long-term results of the HOVON-50 study, published in The Lancet Haematology, indicate that the use of thalidomide in this population is associated with a sustained improvement in survival compared with cytotoxic drugs and interferon alfa.
“Our data support the use of thalidomide as part of induction regimens and maintenance therapy after stem cell transplantation in countries where cost and access to bortezomib and lenalidomide represent important challenges for patients with multiple myeloma and their physicians,” explained Niels W. C. J. van de Donk, MD, of VU University Medical Centre, Amsterdam, Netherlands, and colleagues.
The open-label, phase III trial recruited 536 patients with recently diagnosed myeloma from 44 Dutch and Belgian hospitals. Patients were randomly assigned to receive either three 28-day cycles of vincristine, doxorubicin, and dexamethasone or the same regimen but with thalidomide instead of vincristine. After undergoing stem cell harvest, patients received one or two more courses of treatment with transplantation.
After a median follow-up of 129 months, event-free survival was significantly longer in patients assigned to treatment with thalidomide than in those in the control group. At 10 years, the progression-free survival rate was 21% in the thalidomide groups compared with 9% in the control group. Therapy was discontinued in 42% of patients in the thalidomide arm due to toxicity; 75% of these patients had neuropathy. “Careful follow-up and timely dose adjustments are important to prevent the development of thalidomide-induced neurotoxicity,” concluded the researchers.