HOLLYWOOD, Florida Thalidomide (Thalomid) has "changed the paradigm" for treating multiple myeloma, and advances in understanding the relationship between myeloma cells and the bone marrow microenvironment promise to change it even more, Kenneth C. Anderson, MD, of the Dana-Farber Cancer Institute, said at the National Comprehensive Cancer Network (NCCN) 11th Annual Conference.
Dr. Anderson said that many attempts to develop combination chemotherapy regimens better than melphalan (Alkeran)/prednisone regimens have been largely unsuccessful, but this situation is changing quickly. He expects at least one new drug approval per year over the next few years and a new therapeutic emphasis on targeting not only the tumor cell but also the microenvironment.
"We are getting spoiled in myeloma," Dr. Anderson said, predicting that oncologists will increasingly be able to transform what was an incurable cancer into a manageable chronic illness.
Thalidomide in combination with dexamethasone (Thal/Dex), accounts for part of that optimism. [The FDA recently approved the combination for use in newly diagnosed myeloma patients.] Dr. Anderson said that thalidomide:
Produces a 50% or greater decrease in paraprotein in one-third of relapsed and/or refractory myeloma patients.
Produces a 47% overall response in refractory myeloma.
Has a 63% response rate as initial therapy vs 41% for dexamethasone alone.