ASH 2013 – Maintenance Matters

Paper 2: Initial Phase 3 Results Of The First (Frontline Investigation Of Lenalidomide + Dexamethasone Versus Standard Thalidomide) Trial (MM-020/IFM 07 01) In Newly Diagnosed Multiple Myeloma (NDMM) Patients (Pts) Ineligible For Stem Cell Transplantation (SCT)

The title suggests a comparison of Revlimid with low-dose dexamethasone, called Rd, and an old therapy consisting of melphalan, prednisone, and thalidomide, called MPT.  That comparison is significant in many parts of the world, where MPT is a standard of care for older patients, but MPT is rarely used now in the USA because doctors have newer drugs such as Revlimid, Velcade, Kyprolis and Pomalyst available, and know that those will perform better, even (especially?) in an older population.  This study confirms again that they are correct – Rd thoroughly trounces MPT.

For those of us seniors with access to Revlimid, though, this study clearly demonstrates the advantage of Revlimid maintenance after initial therapy.  It studied 1,623 newly-diagnosed myeloma patients over age 65 or ineligible for transplant, in three study arms: (A) Rd until disease progression; (B) Rd for 72 weeks or progression; and (C) MPT for 72 weeks or progression.

Some results for patients on continuous Rd versus those on 72-week Rd:

  • Median progression-free survival: 26 months versus 21 months.
  • Four-year overall survival: 59% versus 51%.

As time goes on, I would expect the difference in survival to grow.  If this were me, I sure would want to stay on the Revlimid continuously, rather than leave it after a year and a half.

Oh wait, it IS me!  I’m on a study of Pomalyst, in the same family of drugs as Revlimid, and it has kept my cancer under control for five and a half years now.  My study initially included low-dose Dex, just like this study, but my Dex was gradually reduced to zero over about 80 weeks.  For all practical purposes I have been on maintenance, using Pomalyst as a single agent, for at least four years.  During my study I have been able to run 50 marathons, so maintenance has offered a good quality of life.