Expert Point of View: Sergio Giralt, MD

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Sergio Giralt, MD, Chief of Adult Bone Marrow Transplant Service at Memorial Sloan-Kettering Cancer Center, New York, commented on the findings by Papanikolaou et al presented at the 2012 ASCO Annual Meeting.

“To put this trial into context, in a recent study of 283 double-refractory multiple myeloma patients, Kumar et al1 demonstrated a median event-free survival of 5 months and median overall survival of 9 months [after disease proved refractory to bortezomib (Velcade) and patients relapsed following, proved refractory to, or were ineligible to receive an immunomodulatory drug],” Dr. Giralt noted. “The findings from that study are somewhere in the ballpark of what we get with metronomic chemotherapy.”

The Kumar study aimed to elucidate the natural history of patients who become refractory to bortezomib and thalidomide (Thalomid) or lenalidomide (Revlimid) and undergo no further treatment. The study concluded that event-free survival and overall survival are poor in dual-refractory disease.

Relative Benefit

“So the question is, should we be doing this [metronomic chemotherapy] in our practices for patients who have failed all prior treatments? Probably not,” Dr. Giralt concluded.

“Metronomic chemotherapy seems interesting. It can work in heavily pretreated patients. The question is whether it is better than giving palliative care or enrolling patients on phase I/II trials of new agents and strategies, which we should be encouraging,” he maintained.

Dr. Giralt felt, however, that metronomic chemotherapy is worthy of further study. In particular, he continued, investigators need to determine whether it has value earlier in the disease course and as compared with traditional schedules. ■

Disclosure: Dr. Giralt has received honoraria from Millennium and Celgene for consulting and speaker’s bureau activities.

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