The American Society of Clinical Oncology (ASCO) issues an annual report yearly. Revlimid is prominently mentioned in this years report, published in the Journal of Clinical Oncology, in the “Notable Advances” category. Here is what the report had to say about Revlimid (lenalidomide):
Lenalidomide maintenance therapy slows myeloma progression.
Multiple myeloma, a cancer of plasma cells in the bone marrow, is
typically treated with high-dose chemotherapy and autologous stemcell
transplantation, a procedure in which some of a patient’s own
blood stem cells are removed and returned after treatment to rebuild
the immune system. Despite this aggressive approach, more than90%
of patients eventually experience relapse.
New findings from a phase III trial4 showed that adding maintenance
therapy with the drug lenalidomide (Revlimid; Celgene, Summit,
NJ) in patients who had achieved remission after initial therapy
slowed disease progression by 54%. Maintenance therapy is longerterm
treatment given after patients successfully complete initial therapy
with the goal of prolonging remission.
In this study, investigators evaluated more than 600 patients who
were randomly assigned to receive maintenance lenalidomide or placebo
until they experienced disease relapse. All patients had received
previous treatment with high-dose therapy and autologous stem-cell
transplantation, followed by 2 months of lenalidomide treatment after
initial therapy to achieve a complete remission. Investigators found
that adding lenalidomide maintenance therapy almost doubled 3-year
progression-free survival; 68% of patients in the lenalidomide maintenance
group did not experience disease progression compared with
35% of patients in the placebo group who did not experience disease
progression. Overall survival at 2 years was similar in both groups
(95%), and analysis is ongoing. These findings suggest that this approach
can improve quality of life for patients with multiple myeloma
by delaying the need for intensive therapy to treat a relapse.
Remember, measuring time to disease progression is far different than measuring how much longer a patient survives. This all seems to boil down to choice: Does a patient use ongoing maintenance, or wait for relapse and attack the myeloma then. There is no clear-cut answer as to which therapy path works best. Hopefully the picture will become clearer over the next few years.
In the meantime, patients are left to “take their best guess” and “pick a therapy which works best for them.”
Huh? How the heck are patients supposed to know which therapy to select? Just another part of having cancer that sucks!
Even so, we can all try to feel good and keep smiling, right? Pat