18th Congress of EHA

Cyclophosphamide lenalidomide and dexamethasone in newly diagnosed myeloma

Dr Annamaria Brioli - The Institute of Cancer Research, Sutton, UK

Dr Brioli, thank you for agreeing to be interviewed by ecancer in Stockholm. You’ve presented two papers on the use of lenalidomide in the treatment of patients with newly diagnosed multiple myeloma.

Yes.

Can you describe both of these? First of all there was a combination with cyclophosphamide and dexamethasone.

Yes, both of the papers are actually from the same study looking at two different aspects of treatment with the combination of cyclophosphamide, lenalidomide and dexamethasone. The first one is an analysis of the toxicity of this combination in newly diagnosed myeloma patients, both young and old, less fit patients and the other one was an analysis of the rate of second primary malignancies in newly diagnosed patients who have been treated with lenalidomide as an induction and as a maintenance therapy.

Can you tell me what the main findings were, then, of these studies?

We found out that the combination of cyclophosphamide, lenalidomide and dexamethasone is really well tolerated in both young patients and especially, which is most important, in old and less fit patients with not an increase of toxicity and it was easy to deliver to most of the patients. We also looked again, as I said, at the incidence of second primary malignancy and we didn’t find, even if we still have a short follow-up, so of course this data will need to be confirmed with a longer follow-up. We didn’t find an increased risk of developing another second malignancy if treated with an immunomodulatory drug. But again, as I said, this is preliminary data and the follow-up is really short at the moment.

So is it too early, do you think, to talk in terms of these data as far as clinical practice is concerned?

Regarding the combination of cyclophosphamide, lenalidomide and dexamethasone in newly diagnosed patients, no I don’t think it’s too early because we have analysed the toxicity and it was easy to deliver in patients and it’s really feasible so it can already be used in practice. Regarding the potential risk of developing side effects, long-term side effects, of this therapy it might still be a little bit too early but the data so far are really reassuring. So I think it can already be used in practice.

So are we any closer, then, to finding the optimal strategy to use in these patients?

That’s a difficult question. Hopefully yes, there are a lot of different drugs, a lot of different combinations that can be used. We still need to work on how to best rationalise and to deliver the perfect treatment to every single patient but I think we’re getting closer to it. It will still take time though.

And what developments do you hope to see, then, over the next twelve months or so that might get us further forward?

I would hope to see some results of also the earlier clinical trials, ones with even newer drugs which are those results and then maybe start bringing those drugs from the refractory relapsed setting to the newly diagnosed setting.

So you’re quite optimistic, then, about the future?

Yes, but I think it’s going to be longer than twelve months in the future.

Of course. Dr Brioli, thank you very much indeed.

Thank you.