The approval of lenalidomide for the treatment of Multiple Myeloma was based on the results of powerful clinical trials, and constitutes an important step in the approach of patients with relapsed/refractory (rrMM) disease. This paper reports the real life experience of a tertiary cancer center with this drug in rrMM. The overall response rate was 68 % and the median duration of response was 13.6 months. When lenalidomide is used in second line rather than later, quality of response is better, which is associated to longer disease-free and overall survivals.

Authors and Affiliations:

Cristina João, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa

Inês Coelho, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa

Carlos Costa, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa

Susana Esteves, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa

Paulo Lúcio, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa (actualmente hematologista na Fundação Chamaplimaud)

Abstract:

Lenalidomide was approved for the treatment of relapsed and refractory multiple myeloma (rrMM) based on MM009 and MM010 clinical trials. However, its effectiveness and safety profile in real clinical practice should be further assessed. We retrospectively evaluated 90 consecutive patients treated in our center with lenalidomide and dexamethasone (LenDex) between 2007 and 2012. The overall response rate to this treatment was 68 % and the median duration of response was 13.6 months. Patients treated in first relapse and those treated with LenDex longer than 1 year achieved the best responses. Cytogenetics was associated with PFS and best response to treatment was the only variable associated with longer PFS and OS in univariate and multivariate analyses.

Our analysis confirmed that LenDex is effective in rrMM patient, well tolerated, and applicable to the majority of patients outside clinical trials; patients achieving a complete response, even in the context of relapse, have a longer survival; quality of response is better when lenalidomide is used in second line than later on and it is a good surrogate marker for OS. Accordingly, CR should be aimed in the rrMM setting, specialy in fit patients. Previous treatment with thalidomide should not hamper the option for lenalidomide therapy.

Journal: Annals of Hematology, 2014

Link: http://link.springer.com/article/10.1007/s00277-014-2164-3