Challenge yourself with our latest quiz, covering management considerations in the treatment of patients with transplant-ineligible myeloma.
B.Continuous lenalidomide plus dexamethasone
According to the final survival outcomes analysis of data from the phase III FIRST trial, published in the journal Blood, continuous treatment with lenalidomide plus dexamethasone was associated with better PFS outcomes than either 18 cycles of lenalidomide plus dexamethasone or melphalan-prednisone-thalidomide therapy.
According to the final survival outcomes analysis from the FIRST trial, median PFS, the primary study endpoint, was 26 months in patients receiving continuous lenalidomide plus dexamethasone, compared with 21 months for 18 cycles of lenalidomide plus dexamethasone and 21.9 months for melphalan-prednisone-thalidomide. Median overall survival (OS), a secondary study endpoint, was 59.1 months for continuous lenalidomide plus dexamethasone, compared with a statistically similar 62.3 months for 18 cycles of lenalidomide plus dexamethasone, and 49.1 months for melphalan-prednisone-thalidomide.
In the FIRST trial, 30% of patients on continuous lenalidomide plus dexamethasone experienced neutropenia, compared with 45% of patients on melphalan-prednisone-thalidomide and 26% of those receiving 18 cycles of lenalidomide plus dexamethasone. Infections were also less frequent among patients on continuous lenalidomide plus dexamethasone (17%, compared with 32% of patients receiving melphalan-prednisone-thalidomide or and 22% of those receiving 18 cycles of lenalidomide plus dexamethasone).
According to the 2018 FIRST trial report in Blood, more than half of study participants received a bortezomib-based second-line therapy and outcomes (time to third-line regimen and median OS time) were better among those patients if they had received first-line lenalidomide plus dexamethasone rather than melphalan-prednisone-thalidomide.
C.Twelve cycles of melphalan-prednisone-thalidomide
Thrombocytopenia was reported for 9%, 8%, and 11% of patients in the continuous lenalidomide–plus-dexamethasone group, 18-cycles of lenalidomide–plus-dexamethasone group, and the melphalan-prednisone-thalidomide group, respectively. Peripheral sensory neuropathy was seen in 1%, < 1%, and 9%, respectively. (There was no study arm for continuous melphalan-prednisone-thalidomide treatment.)