Newer Drug Helps Older Myeloma Patients
Treatment may extend survival for patients over 65, researchers say
"Transplants seem to have a clear advantage," Avigan said. But he pointed out that other drug combinations are available for myeloma, and this study tested only one.
The study also looked at the effects of "maintenance" therapy with lenalidomide (Revlimid) after patients had their transplant or combination-drug therapy. That meant taking lenalidomide pills until their cancer came back. The drug appeared to extend patients' time in remission, but not their overall survival.
Lenalidomide is already commonly used as a maintenance therapy, but there have been reservations about it, Avigan said.
It has side effects, such as infections, and some patients using it have developed second cancers, such as leukemia or lymphoma. Plus, maintenance therapy with the drug -- which costs about $160,000 a year in the United States -- hasn't yet been shown to extend patients' lives.
"But it does prolong the period of remission," Avigan said. "And for many people, that's enough."
However, many patients with myeloma aren't eligible for a stem cell transplant, including those older than 65 or 70.
"At least 50 percent of patients with newly diagnosed myeloma are considered transplant-ineligible," said Dr. Thierry Facon, the senior researcher on the second study.
In Europe, patients who can't have a transplant usually receive a particular triple-drug combination, said Facon, a hematologist at University Hospital of Lille in France.
To see whether lenalidomide plus an anti-inflammatory drug -- dexamethasone -- might work better, they recruited more than 1,600 transplant-ineligible myeloma patients. One-third were randomly assigned to 72 weeks of a standard drug combo (melphalan, prednisone and thalidomide); another third took lenalidomide/dexamethasone over 72 weeks; and the final third kept taking the drug duo until their cancer progressed.
Overall, the study found, patients fared best with continuous lenalidomide. They typically went more than 25 months with no cancer progression versus around 21 months with the other two treatments.
Their longer-term outlook was also brighter. At four years, 59 percent were still alive, compared with 56 percent of patients who received lenalidomide for only 72 weeks, and 51 percent of those given the standard drug regimen.