Multiple myeloma: cyclophosphamide overcomes pomalidomide resistance

  • Weisel KC & al.
  • Blood Cancer J
  • 8 Apr 2019

  • curated by David Reilly
  • Univadis Clinical Summaries
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Takeaway

  • In patients with relapsed/refractory (R/R) multiple myeloma (MM), the addition of cyclophosphamide (CY) to pomalidomide+dexamethasone (POM+DEX) enabled patients to overcome pomalidomide resistance and achieve an improved response.

Why this matters

  • Prognosis is poor in patients with R/R MM.

Study design

  • Phase 2 PERSPECTIVE study to investigate the addition of CY after an insufficient response to 3 cycles of POM+DEX in 60 patients with R/R MM.
  • Patients had received a median of 3 prior treatment lines.
  • Funding: Celgene Corp.  

Key results

  • Best response to cycles 1-3 of POM+DEX (n=59) vs best response after the addition of CY (n=36):
    • Objective response rate: 18.6% vs 36.1%.
    • Partial response: 15.2% vs 22.2%.
    • Very good partial response: 3.4% vs 8.3%.
    • Complete response: 0% vs 5.6%.
    • Progressive disease: 18.6% vs 0%.
    • Stable disease: 39.0% vs 33.3%.
    • Minimal response: 20.3% vs 27.8%.
  • Median PFS in the intent-to-treat population who received POM+DEX only, 6.4 months; median second PFS from initiation of CY in patients who received the triplet, 4.8 months.
  • Most common hematologic and nonhematologic adverse events: neutropenia (66.6%) and pneumonia (16.7%), respectively.

Limitations

  • Protocol violations or other issues prevented 14 patients from receiving CY.

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