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2018 ASCO: Pomalidomide, Bortezomib, and Low-Dose Dexamethasone in Relapsed or Refractory Multiple Myeloma

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Key Points

  • After a median of 16 months, those who received pomalidome, bortezomib, and low-dose dexamethasone had a 39% lower risk of disease progression or death than those who received bortezomib and low-dose dexamethasone.
  • The most common side effects of the drug combinations were neutropenia, infections, and thrombocytopenia, which were largely manageable.

For patients with multiple myeloma who have been treated with lenalidome (Revlimid) but have relapsed and not responded to other therapy, a three-drug combination can significantly extend the time in which the disease is held in check. The findings of the phase III OPTIMISMM trial were presented by Richardson et al at the 2018 ASCO Annual Meeting (Abstract 8001).

More on OPTIMISMM

The trial enrolled 559 patients who had relapsed after treatment with lenalidomide. Two hundred and eighty-one patients were treated with pomalidomide (Pomalyst), bortezomib (Velcade), and low-dose dexamethasone; 278 were treated with only bortezomib and low-dose dexamethasone. All patients had prior lenalidomide (71% vs 69% lenalidomide-refractory); 72% vs 73% had prior bortezomib; and 70% vs 66% were refractory to their last treatment. Median prior treatment lines was 2; 40% in the pomalidomide, bortezomib, and low-dose dexamethasone arm and 41% in the  bortezomib and low-dose dexamethasone arm had 1 prior treatment line.

After a median of 16 months, those who received pomalidome, bortezomib, and low-dose dexamethasone had a 39% lower risk of disease progression or death than those who received bortezomib and low-dose dexamethasone. The most common side effects of the drug combinations were neutropenia, infections, and thrombocytopenia, which were largely manageable.

“Despite important recent advances in the treatment of multiple myeloma, there remains an unmet medical need for those patients who have received lenalidomide-based therapies and are in early relapse,” said Paul Richardson, MD, Clinical Program Leader and Director of Clinical Research, Jerome Lipper Multiple Myeloma Center at Dana-Farber Cancer Institute. “These are the first phase III clinical findings to report a significant and clinically meaningful progression-free survival in patients who have previously received lenalidomide, and especially those who are lenalidomide-refractory. Pomalidomide/bortezomib/dexamethasone provides a new therapeutic platform for yet further treatment advances such as the incorporation of monoclonal antibodies.”

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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