Could lenalidomide delay the onset of myeloma-related bone, organ damage?

Could lenalidomide delay the onset of myeloma-related bone, organ damage?
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According to the Eastern Cooperative Oncology Group, lenalidomide, a cancer drug, may delay the onset of bone and other myeloma-related organ damage.

Published in the Journal of Clinical Oncology, the largest randomised trial in asymptomatic patients with multiple myeloma suggests that the cancer drug, lenalidomide, may delay the onset of bone and other myeloma-related organ damage. The study was conducted by the Eastern Cooperative Oncology Group and funded by the National Cancer Institute.

“High-risk smouldering multiple myeloma”

“Our findings are in line with a smaller trial in 2015 by researchers in Spain,” says Vincent Rajkumar, a Mayo Clinic haematologist and senior author of the paper.

“In conjunction with the Spanish data, our findings support early therapy for patients with high-risk smouldering multiple myeloma.”

The current standard of care for smouldering multiple myeloma is observation without therapy. “Early treatment with lenalidomide delays progression to symptomatic myeloma and can prevent damage to organs that occurs in multiple myeloma,” says Rajkumar.

Details of the study

The study included 182 patients, 92 of whom received lenalidomide. The other 90 patients did not receive the drug but were observed, as in common practice.

Almost half of the patients receiving the drug responded to therapy, while no change was reported among patients who were observed without treatment. The time to disease progression from symptomatic myeloma was significantly longer in patients receiving lenalidomide, compared to patients who did not receive therapy.

“Six patients in the study died – two in the group receiving lenalidomide and four in the observation group,” says Rajkumar. “It is too early to determine the impact of treatment on overall survival.”

Rajkumar says serious adverse events occurred in 28% of patients on lenalidomide, but he says those events were considered manageable with dose reduction.

“Possible to delay progression”

“These results, in combination with the findings in the 2015 Spanish study, support a change in the standard of care for intermediate and high-risk smouldering myeloma patients,” says Rajkumar.

“We show that it is possible to delay progression to multiple myeloma, a serious cancer with significant morbidity, by early therapy administered when the disease is still asymptomatic.”

The Spanish study involved two drugs, lenalidomide and dexamethasone, a steroid, and found that early therapy delayed progression and also improved overall survival.

However, the findings did not lead to a change in practice, partly because it was not clear whether the beneficial effect was due to the therapeutic effect of the drugs independently or in Rajkumar says the study, involving researchers from across the US, shows that lenalidomide alone has a similar effect of delaying disease progression.

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