ASH 2018: Frailty-Adjusted Treatment Approach for Elderly Patients With Myeloma
Posted: Wednesday, December 12, 2018
Although the outcome of elderly patients with multiple myeloma is influenced by several factors, including age, comorbidities, physical fitness, and cognitive function, evidence-based treatments based on patients’ frailty are still lacking. In a recent phase III study, the researchers observed a comparable outcome between dose/schedule-adjusted lenalidomide/dexamethasone therapy and a full-dose continuous schedule in patients with newly diagnosed multiple myeloma who were identified as intermediate-fit on the frailty scale. The findings were presented at the 2018 American Society of Hematology (ASH) Annual Meeting & Exposition in San Diego (Abstract 305).
“These results confirm the need for an appropriate definition of patient frailty and pave the way to a frailty-adjusted treatment approach to better balance efficacy and safety in elderly [newly diagnosed multiple myeloma] patients,” stated Alessandra Larocca, MD, PhD, of the European Myeloma Network and the University of Torino Hospital in Torino, Italy, and colleagues.
A total of 199 intermediate-fit newly diagnosed patients, identified by an International Myeloma Working Group (IMWG) total frailty score of 1, were randomly assigned to receive either dose/schedule-adjusted lenalidomide/dexamethasone therapy followed by lenalidomide maintenance or continuous lenalidomide/dexamethasone. No difference in progression-free survival (18.3 vs. 15.5 months) and 18-month overall survival (85% vs. 81%) was observed in the frailty-adjusted versus continuous-dosing groups, respectively. However, the continuous-dosing group did have a significantly higher event-free survival (9.3 vs. 6.6 months, P = .04).
As for safety, the continuous-dosing group experienced more frequent hematologic grade 4 and nonhematologic grade 3 and 4 adverse events compared with the frailty-adjusted group (39% vs. 30%). However, the difference did not reach statistical significance.