Continuous Revlimid/Lose-Dose Dexamethasone Improves Outcomes in Newly Diagnosed Multiple Myeloma

Among people with newly diagnosed multiple myeloma who are ineligible for stem cell transplantation, continuous treatment with Revlimid® (lenalidomide) and low-dose dexamethasone results in better overall survival than standard treatment with melphalan, prednisone, and thalidomide. These results were presented at the 2013 Annual Meeting of the American Society of Hematology.

Multiple myeloma is a cancer of plasma cells, which are a special type of white blood cell that are part of the body’s immune system. Patients with multiple myeloma have increased numbers of abnormal plasma cells that may produce increased quantities of dysfunctional antibodies detectable in the blood and/or urine.

With current therapy, curing patients with multiple myeloma is uncommon; recent advances in treatment, however, have prolonged survival by several years. For patients who are not candidates for stem cell transplantation, initial treatment often involves treatment with a combination of melphalan, prednisone, and thalidomide. To compare this approach with two alternative approaches, researchers conducted a Phase III clinical trial known as FIRST. The study enrolled 1,623 patients with newly diagnosed multiple myeloma who were not candidates for stem cell transplantation because of age or other reasons.

Study participants were assigned to one of three treatments: 1) 72 weeks of treatment with melphalan, prednisone and thalidomide; 2) 72 weeks of treatment with Revlimid and low-dose dexamethasone; or 3) continuous treatment (treatment until disease progression) with Revlimid and low-dose dexamethasone

  • Compared with the standard treatment of 72 weeks of melphalan, prednisone, and thalidomide, continuous treatment with Revlimid and low-dose dexamethasone improved overall survival. Median survival without cancer progression was 25.5 months for continuous Revlimid and low-dose dexamethasone, and 21.2 months for melphalan, prednisone, and thalidomide.
  • Four-year overall survival was 59% with continuous Revlimid and low-dose dexamethasone, 55.7% with 72 weeks of treatment with Revlimid and low-dose dexamethasone, and 51.4% with 72 weeks.

These results suggest that continuous treatment of newly diagnosed multiple myeloma with a combination of Revlimid and low-dose dexamethasone improves outcomes in patients who are not eligible for stem cell transplantation.

Reference: Facon T, Dimopoulos MA, Dispenzieri A et al. 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). Presented at the 55th ASH Annual Meeting and Exposition. New Orleans, LA. December 7-10, 2013. Abstract 2.

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