According to results recently presented at the 2007 annual meeting of the American Society of Hematology, use of low doses of the steroid dexamethasone in combination with Revlimid® (lenalidomide) provided significantly improved survival in multiple myeloma compared with higher-doses of the steroid in this treatment combination.
Multiple myeloma is a cancer of the blood that affects the plasma cells. Plasma cells are an important part of the immune system; they produce antibodies to help fight infection and disease. Multiple myeloma is characterized by an excess production of abnormal plasma cells. Symptoms include increased risk of bacterial infections and impaired immune responses.
Revlimid, an immunomodulatory agent, fights cancer through several biological mechanisms, many of which are still being evaluated. One action Revlimid uses against cancer is to prevent or reduce blood vessel growth to the cancer. This ultimately “starves” the cancer cells of nutrients and oxygen. Revlimid continues to be evaluated in clinical trials for various types of cancers. Revlimid is typically used in combination with the steroid dexamethasone; one concern about this combination is that high doses of dexamethasone are associated with an increased risk of thrombotic events (blood clots).
Researchers recently reported longer follow-up results from a clinical trial comparing different doses of dexamethasone in combination with Revlimid for the treatment of multiple myeloma. This trial included 445 patients with newly diagnosed multiple myeloma who were treated with either lower doses or higher doses of dexamethasone in addition to Revlimid. The median follow-up for these patients is 21 months.
- At one year survival was 96% for patients treated with lower-dose dexamasone and 88% for patients treated with higher-dose dexamethasone.
- At two years survival was 87% for patients treated with lower-doses of dexamethasone and 75% for those treated with higher-doses of dexamethasone.
- Anticancer response rates were lower for lower-dose dexamethasone.
- Lower doses of dexamethasone reduced severe side effects.
The researchers concluded that, despite lesser anticancer responses, lower doses of dexamethasone used in combination with Revlimid provide better survival than higher-dose dexamethasone used in this treatment combination. Patients with newly diagnosed multiple myeloma may wish to speak with their physician regarding their individual risks and benefits of all treatment options.
Referece: Rajkumar SV, et al. A randomized trial of Lenalidomide plus high-dose dexamethasone versus lenalidomide plus low-dose dexamethasone in newly diagnosed multiple myeloma: a trial coordinated by the Eastern Cooperative Oncology Group. Proceedings from the 2007 annual meeting of the American Society of Hematology. Abstract 74.