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An Ambiguous Multiple Myeloma Maintenance Therapy Study Is Still Worth A Look

Home/An Ambiguous Multiple Myeloma Maintenance Therapy Study Is Still Worth A Look

An Ambiguous Multiple Myeloma Maintenance Therapy Study Is Still Worth A Look

Here is a research study abstract I found on HemOnctoday.com., posted May 11, 2010:

Maintenance with thalidomide improved PFS, not OS in multiple myeloma.

Maintenance therapy with thalidomide extended PFS for patients with multiple myeloma, but such therapy did not result in a similar benefit for OS, according to results from a European study.

From August 2001 to October 2007, researchers at 26 clinics in central and eastern Europe recruited 249 patients who were not eligible for autologous stem cell transplantation. Those patients were treated with thalidomide-dexamethasone or melphalan-prednisolone as induction therapy.

After nine cycles of treatment, 128 patients had stable disease and were eligible for maintenance therapy with thalidomide plus interferon alfa-2b (n=64) or interferon alone (n=64). The median age in the cohort was 72 years.

The median follow-up was 35 months. The median duration of maintenance therapy was 13.2 months for patients assigned thalidomide and 8.3 months for those assigned interferon alone. The median daily dose of thalidomide was 75 mg (25 mg-200 mg), with a median cumulative dose of 28.4 mg. The median weekly dose of interferon was 9 megaunits, with a median cumulative dose of 258 megaunits.

Maintenance therapy with thalidomide improved depth of response from partial response to very good partial response or complete response in 8% of patients compared with 3% for interferon. PFS was 27.7 months for those assigned thalidomide compared with only 13.2 months for those assigned interferon alone (HR=0.55; 95% CI, 0.36-0.86).

OS was 52.6 months in patients receiving thalidomide and 51.4 months in those being treated with interferon alone (HR=0.93, 95% CI, 0.53-1.66). When patients were analyzed according to age, there was no difference in OS between patients aged younger than 75 years and older patients.

Ludwig H. Haematologica. 2010;doi:10.3324/haematol.2009.020586.

Please note the statements highlighted in bold type.  Thalidomide maintenance therapy helped patients achieve and maintain a better response.  So you would think using Thalomid as maintenance therapy would also extend patient lives.  WRONG!  There we go assuming again!  You can see using interferon did little good at all–consider it more like a placebo.  Chances are drug free results would have been similar to those with interferon–but that would require more assumptions, wouldn’t it?  One bright spot:  a 50+ month median survival rate is pretty good for a group of patients with an average age of 72, don’t you think?  That is almost a year longer than patients this age would be, on average, expected to live until very recently.
 
So what does all of this mean?  Who knows?  Why did I run it?  To illustrate how sometimes medical advances don’t move in straight lines.  To show how better overall medical care is extending average life expectancies.  Most importantly, to remind all of us that reaching a goal (like a very good partial response or very good response or even a complete response) doesn’t necessarily mean a patient will ultimately live longer.  Unfair, but true–sometimes.  Median survival data is just an average.  I feel I’m better and luckier and more determined than the average patient.  How about you?
 
Feel good and keep smiling!  Pat