Multiple myeloma: PFS improves with response-adapted therapy

  • Lancet Haematol
  • 14 Oct 2019

  • curated by Craig Hicks
  • Univadis Clinical Summaries
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • Switching to proteasome inhibitor-based combination therapy significantly improves PFS in patients with newly diagnosed multiple myeloma (MM) after suboptimal response to first-line immunomodulatory agents.

Why this matters

  • These results suggest that chemotherapy agents with different mechanisms of action should be used in combination during initial therapy, if available and tolerable; otherwise, agent class should be switched rapidly after suboptimal response to initial treatment, with the aim of response intensification to prolong PFS.
  •  See related commentary: Frontline therapy in multiple myeloma: fast start for a long game.

Study design

  • Researchers in this phase 3 trial studied effects of intensification treatment for newly diagnosed MM with cyclophosphamide, bortezomib, and dexamethasone (CVD) after partial or minimal response to first-line combinations of cyclophosphamide, lenalidomide or thalidomide, and dexamethasone.
  • They randomly assigned patients either to CVD (n=289) or no treatment (n=294).
  • Funding: Cancer Research UK; Celgene; Amgen; MSD; Myeloma UK.

Key results

  • Median PFS with CVD was 30 months, and without CVD was 20 months (HR, 0.60; 95% CI, 0.48-0.75; P<.0001>
  • 3-year OS with CVD was 77.3%, and without CVD was 78.5% (HR, 0.98; 95% CI, 0.67-1.43; P=.93).
  • Most common adverse events with CVD were neutropenia (7%), thrombocytopenia (7%), and anemia (3%), with no treatment-related deaths.

Limitations

  • The trial was open label.