Pretreated Multiple Myeloma: Pomalidomide Plus Bortezomib/Dexamethasone
Posted: Wednesday, August 21, 2019
According to data from the phase III OPTIMISMM trial, published in The Lancet Oncology, patients with relapsed or refractory multiple myeloma previously treated with lenalidomide experienced improved survival outcomes when pomalidomide was added to a follow-up treatment of bortezomib and dexamethasone. Paul G. Richardson, MD, of the Dana-Farber Cancer Institute, and colleagues believe their findings support the use of this regimen in this patient population.
Between January 2013 and May 2017, the study enrolled 559 patients with measurable and diagnosed multiple myeloma who had previously received lenalidomide treatment for at least two consecutive cycles. Patients were randomly assigned to receive either bortezomib and dexamethasone (n = 278) or bortezomib, dexamethasone, and pomalidomide (n = 281).
At a median follow-up of 15.9 months, the pomalidomide group saw markedly improved progression-free survival of 11.2 months compared with 7.1 months for the bortezomib and dexamethasone group. Overall, eight treatment-related deaths occurred—six in the pomalidomide group attributed to pneumonia, cardiac arrest, cardiorespiratory arrest, and other unknown causes; two in the other group, due to pneumonia and hepatic encephalopathy. The most common grade 3 or 4 treatment-emergent adverse events included neutropenia, infections, or thrombocytopenia. A total of 159 patients in the bortezomib and dexamethasone group experienced serious adverse events versus 114 in the pomalidomide group.
All patients received 1.3 mg/m2 of bortezomib intravenously until protocol amendment 1 and continued receiving bortezomib either intravenously or subcutaneously on days 1, 4, 8, and 11 for the initial 8 treatment cycles and on days 1 and 8 beyond that, in addition to taking 20 mg (10 mg for patients older than age 75) of dexamethasone orally on the same days as bortezomib was administered, plus the following day. The pomalidomide group received 4 mg of pomalidomide orally on days 1 and 8. All patients were on 21-day treatment cycles.
Disclosure: The study authors’ disclosure information may be found at thelancet.com.