If an elderly multiple myeloma patient receives thalidomide on top of his/her chemotherapy treatment of melphalan plus prednisone his/her survival improves substantially, according to an article in The Lancet, this week’s edition.
For over four decades combination chemotherapy with melphalan and prednisone (MP) has been given to patients with multiple myeloma – it is still the most commonly accepted treatment option for older patients who cannot be given higher dose therapy.
Professor Thierry Facon, Hôpital Claude Huriez, Centre Hospitalier Universitaire de Lille, Lille, France, and team from the Intergroupe Francophone du Myelome (IFM) carried out a study involving 447 multiple myeloma patients who were previously untreated, aged 65-75 years. 196 of them were randomly selected to receive MP, another 125 were randomly selected to receive MP + thalidomide (MPT), while the rest (126) received reduced-intensity stem cell transplantation using melphalan (MEL 100).
After a follow up of 51.5 months (median), overall survival times were:
— 33.2 months for the MP group
— 51.6 months for the MPT group
— 38.3 months for the MEL 100 group
The MPT regimen gave substantially better survival times than the other two.
“Our study has shown that the addition of thalidomide to standard melphalan and prednisone significantly extended survival for elderly patients with previously untreated multiple myeloma. We noted that the MPT regimen was better than the MP regimen in terms of response, including complete response, overall survival, and progression-free survival,” explained the authors.
“The results of our trial provide strong evidence to suggest that the MPT combination, should, at present, be the reference treatment for previously untreated elderly patients with multiple myeloma. After 40 years of unsuccessful attempts to find a more effective treatment than the standard MP, the MPT combination opens an era of progress for elderly patients with this disease,” the scientists concluded.
“After 50 years of unsuccessful attempts to find new and more effective treatment approaches suitable for most patients, we now have extensive evidence to support the introduction of MPT as the standard of care for elderly patients with multiple myeloma,” Dr Antonio Palumbo and Dr Mario Boccadoro, University of Torino, Italy, wrote in an accompanying Comment.
Written by: Christian Nordqvist