Multiple myeloma: pomalidomide-based triplet reduces progression

  • Richardson PG, et al.
  • Lancet Oncol
  • 13 May 2019

  • curated by David Reilly
  • 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
  • The addition of pomalidomide to bortezomib+dexamethasone significantly improved PFS in patients with relapsed/refractory multiple myeloma (R/R MM) previously treated with lenalidomide.
Why this matters
  • Patients with early-line, lenalidomide-pretreated R/R MM constitute a growing patient population commonly excluded from clinical trials.
Study design
  • Phase 3 study to investigate bortezomib+dexamethasone with (n=281)/without (n=278) pomalidomide in 559 patients with R/R MM previously treated with lenalidomide.
  • 70% of patients were lenalidomide-refractory.
  • Funding: Celgene.  
Key results
  • Median PFS with the triplet: 11.20 (95% CI, 9.66-13.73) months; median PFS with the double: 7.10 (95% CI, 5.88-8.48) months; HR, 0.61 (95% CI, 0.49-0.77; P<.0001>
  • In lenalidomide-refractory patients:
    • Median PFS with the triplet: 9.53 (95% CI, 8.05-11.30) months; median PFS with the doublet: 5.59 (95% CI, 4.44-7.00) months; HR, 0.65 (95% CI, 0.50-0.84; P=.0008).
  • Very good partial response or better: 52.7% (95% CI, 46.7%-58.6%) with the triplet vs 18.3% (95% CI, 14.0%-23.4%) with the doublet.
  • Most common grade 3-4 hematological adverse events with the doublet vs triplet, respectively:
    • Neutropenia: 9% vs 42%.
    • Thrombocytopenia: 29% vs 27%.
  • 8% grade 3-4 peripheral neuropathy with the triplet vs 4% with the doublet.
  • Limitations
    • Open-label study.