18th Congress of EHA

Second line treatment of multiple myeloma with melphalan prednisone and lenalidomide

Prof Meletios Dimopoulos - University of Athens, Greece

Good morning Dr Dimopoulos, thank you for joining us at ecancer.

Good morning.

Can you tell me something about the current state of play as far as the second line treatment of multiple myeloma is concerned?

Yes, this is a rapidly evolving field because we have several novel agents, actually a second generation of novel agents, that are emerging with significant activity in relapsed refractory myeloma and also in the second line patients. So in this meeting we present the second line treatment data on patients who were randomised in the MMO15 trial, this is a trial which randomised non-transplant eligible patients to receive either melphalan prednisone for nine courses or melphalan prednisone lenalidomide for nine courses or the third arm patients received melphalan prednisone lenalidomide for nine courses followed by lenalidomide maintenance. We know that lenalidomide maintenance was associated with a longer progression free survival and this was the main finding of the study indicating the value of lenalidomide as a maintenance treatment in patients with myeloma who are not eligible for high dose therapy.

In this meeting we are presenting the outcome of the patients who progressed in each of these three arms, the type of second line therapy that they had received and we are particularly interested in those patients who received second line therapy with lenalidomide. We were able to show that prior treatment with lenalidomide was not associated with the development of resistance. Of course I would like to note that patients who progressed on lenalidomide maintenance did so at low dose of lenalidomide and they experienced primarily biochemical progression. Thus, these patients were able to be rescued again with increasing the dose of lenalidomide and adding dexamethasone.

Overall the main finding of this analysis is that patients do not appear to develop resistance with prior treatment with lenalidomide and they can derive a significant benefit from second line therapies.

So in your view does this represent a significant advance in the treatment of these patients?

I think it’s useful information because whenever we have a patient who is being maintained with something, there is always a concern whether at the time of progression what would be the characteristics of this disease, whether he will have a more aggressive disease, a more resistant disease. So it is always useful information to know.

Thank you very much indeed.