Innovative therapy improving responses and survival in Multiple Myeloma patients

9 Jun 2009

Data from multiple studies presented at the 14th Congress of the European Society of Hematology demonstrate that lenalidomide (Revlimid®) provides powerful and sustained responses in patients with multiple myeloma. These key presentations support the advantage of active long-term disease control along with manageable safety profiles, leading to unprecedented survival times.

“Together, the studies presented at this congress demonstrate that the use of Revlimid early on in the course of the disease allows for rapid and durable responses that lead to the best survival benefits we’ve seen yet for this patient population,” said Jean-Pierre Bizzari, Group Head of Global Oncology/Hematology for Celgene. “We are excited that the dual mode of action of Revlimid, which includes both a direct killing effect against myeloma cells and a unique immune-enhancing effect, controls and manages the disease over the long-term.”

Speed of response with lenalidomide and dexamethasone in patients with relapsed or refractory multiple myeloma: First results of the MM-019 German compassionate use protocol

Treatment time required for patients with multiple myeloma to respond to therapy with lenalidomide plus dexamethasone was examined in a phase IIIb, open-label, non-comparative trial. Patients had received at least one previous therapy and were treated in 28-day courses that were repeated until disease progression, toxicity or withdrawal by the physician or patient.

Patients’ previous therapies, including transplantations, bortezomib and thalidomide, did not influence response rates. Fifteen patients (12%) had been previously treated with all three regimens, 43 (35%) with two and 42 (34%) with one.

Best response information, measured by levels of M protein and free light chains (FLC), was available for 113 patients, including four patients with a complete response, 80 with a partial response, 28 with stable disease and one with disease progression.

Time to a 50 percent reduction in M-protein or FLC was analysed for 122 patients. For responding patients, median time to response was 28 days, with 39 percent of patients seeing a response in two weeks.

“These data demonstrate that nearly three-quarters of patients achieved a partial response or better, despite having been heavily pretreated,” said Dr. Katja Weisel of University Hospital in Tübingen, Germany. “The responses were rapid, with half of the patients responding well within the first treatment course.”

Longer duration of treatment and maintenance of best response with lenalidomide plus dexamethasone increases overall survival (OS) in patients with relapsed/refractory multiple myeloma

A subset analysis of updated, pooled data from the MM-009/MM-010 international phase III trials demonstrated a survival benefit upon continued treatment with lenalidomide plus dexamethasone after achieving best clinical response in patients with relapsed or refractory multiple myeloma.

Survival estimates for patients achieving a partial response or better were compared between patients on continuous treatment (those still undergoing treatment or who discontinued due to disease progression) and patients who discontinued treatment early due to adverse events, consent withdrawal or other reasons. Median follow-up time for surviving patients was 48 months.

The estimated median survival time for patients continuing treatment after achieving a partial response or better (N=174) was 50.9 months [95% confidence interval: 43.0-NR], while the median survival time for those who discontinued treatment early (N=38) was 34.95 months [26.4-55.7; P=0.0594].

When differences in the groups’ patient characteristics (such as age, number of prior treatments, etc.) were also taken into account, the group that continued treatment had significantly better survival outcomes than did the group that discontinued therapy.

The number of patients who discontinued early due to adverse events was low (N=22, 10%).

“This study suggests that therapy with lenalidomide plus dexamethasone should be prolonged even after the patient achieves an initial response,” concluded Dr. Jesus San Miguel of the University Hospital of Salamanca in Salamanca, Spain. “The lasting effects gained by additional rounds of treatment may significantly prolong survival for these patients.”

Lenalidomide-based therapy leads to improvement in humoral immune system in relapsed or refractory multiple myeloma patients who respond to the therapy

Dr. Rachid Baz of the Moffitt Cancer Center & Research Institute, in Tampa, FL, USA presented another analysis of MM-009/MM-010, as well as of a large phase II study of lenalidomide as a single agent therapy in patients with relapsed or refractory multiple myeloma, demonstrated that lenalidomide therapy improves patient immunity by boosting immunoglobulin A (IgA) levels.

Levels of IgA, an important antibody for fighting infections, are commonly reduced in patients with multiple myeloma. These low levels are associated with recurrent bacterial infections – the most common cause of death for patients in advanced stages of the disease.

The study measured baseline levels of the antibodies and evaluated antibody responses to therapy on a monthly basis. Improvement was defined as an increase in antibody levels to at least the lower limit of normal and a 25 percent increase in value.

Only patients who responded to therapy showed significant improvement and normalisation of residual IgA levels. At baseline, residual IgA levels were normal in 30 and 17 percent of responders in MM-009/MM-010 and MM-014, respectively. With treatment, normalised IgA levels were found in 56 percent of responders in MM-009/MM-010 by cycle seven and in 50 percent of responders in MM-014 by cycle five.

Patients whose IgA levels normalised had significantly longer progression-free (29-77 weeks) and overall (121-220 weeks) survival times compared to those whose IgA levels did not improve (P=0.0001).

Lenalidomide in combination with dexamethasone at first relapse in comparison with its use as later salvage therapy in relapsed or refractory multiple myeloma

Also of note is a study that was recently published in the European Journal of Hematology. This subset analysis of MM-009/MM-010 demonstrated the benefit of initiating lenalidomide plus dexamethasone at first relapse compared to later salvage therapy.

The study showed that, with lenalidomide plus dexamethasone, patients who had received one prior therapy demonstrated significant improvements compared to those who had received two or more prior therapies in outcomes such as median time to disease progression (17.1 vs. 10.6 months; P=0.026), median progression-free survival (14.2 vs. 9.5 months; P=0.047), complete or very good partial responses (39.8% vs. 27.7%; P=0.025) and median overall survival (42.0 vs. 35.8 months; P=0.041).

“These results suggest that it may be beneficial to patients to be treated with lenalidomide plus dexamethasone earlier on in the treatment course,” said Dr. Edward A. Staudtmauer of the Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA. “Based on the findings, the combination of lenalidomide and dexamethasone should be considered as a second-line therapy for patients with multiple myeloma.”

Source: Celgene International Sàrl