Is There a Role for Consolidation Treatment in Newly Diagnosed Patients With Multiple Myeloma?
Posted: Friday, November 5, 2021
According to the findings of the phase III EMN02/HOVON95 trial, presented in the Journal of Clinical Oncology, for patients with newly diagnosed multiple myeloma, treatment with bortezomib, lenalidomide, and dexamethasone (VRD), followed by maintenance with lenalidomide, may lead to improved progression-free survival and quality of response, compared with lenalidomide maintenance alone. Michele Cavo, MD, of the University of Bologna, Italy, and colleagues noted that the rates of toxicity and second primary malignancies were considered to be acceptable with consolidation treatment.
In this trial, the authors randomly assigned 878 patients with newly diagnosed multiple myeloma to receive two cycles of consolidation treatment with VRD (451 patients) or no consolidation after induction and intensification therapies (427 patients).
At a median follow-up of 74.8 months, the authors found that patients who received consolidation had longer progression-free survival than those who did not receive consolidation (59.3 months vs. 42.9 months, respectively). This increase in progression-free survival was observed in all predefined subgroups, including those based on the revised International Staging System stage, cytogenetics, and prior treatment status.
The median duration of maintenance with lenalidomide for all patients was 33 months. For those who received consolidation therapy, 34% had at least a complete response to treatment before starting maintenance therapy, compared with 18% of those not treated with consolidation.
As for overall survival, the authors reported a “trend” to improvement with consolidation therapy. However, median overall survival was not reached at 84 months in both arms, although the overall survival curves separate after 5 to 6 years.
In a subgroup of 226 patients who demonstrated a complete response, stringent complete response, or very good partial response, 74% of those who received consolidation treatment achieved minimal residual disease negativity.
Disclosure: For a full disclosure of the study authors, visit ascopubs.org.
