Comparison of First-Line Treatments in Older Patients With Myeloma
Posted: Thursday, October 24, 2019
According to research presented at the 2019 International Myeloma Workshop in Boston (Abstract OAB-011), a combination treatment of lenalidomide, bortezomib, and dexamethasone (RVD) may lead to improved survival outcomes for some older patients with myeloma compared with treatment with doublets of lenalidomide and dexamethasone (RD) or bortezomib and dexamethasone (VD).
“RVD offers time to treatment failure and overall survival benefit for older patients with myeloma who can tolerate higher potential short-term toxicity, confirming the results of the SWOG S0777 in a population-based setting,” concluded Adam Olszewski, MD, of Brown University, and colleagues.
The study used Medicare claims linked to cancer registry Surveillance, Epidemiology, and End Results data to identify Medicare recipients with an average age of 76 who had been diagnosed with myeloma and who were receiving first-line treatment with RD, VD, or RVD between 2007 and 2015. In that time, increases were observed in patients receiving RD (18%–25%, n = 1,541), VD (17%–26%, n = 1,672), and RVD (1%–26%, n = 891). A total number of 4,104 patients were analyzed.
When compared with doublets, RVD treatment resulted in improved time to treatment failure (median 1.7 years vs. 0.8 years) and overall survival (median 3.4 years vs. 2.7 years), although RVD also was associated with higher hospitalization rates and occurrences of anemia and neuropathy. However, it did not increase the instances of thromboembolism, and patients receiving RVD were more likely to undergo consolidative transplant (26% vs. 6%).
When the investigators analyzed doublets alone, RD was linked to superior time to treatment failure (median 1.0 years vs. 0.6 years) and overall survival (median 2.7 years vs. 2.3 years) compared with VD treatment. Although RD was associated with more frequent occurrences of thromboembolism, the instances of neuropathy were less common than with VD, and hospitalization and anemia rates were comparable between the two treatments.
Disclosure: The study authors’ disclosure information can be found at imw2019boston.org.