Redefining the treatment paradigm for multiple myeloma
Mené sur 559 patients atteints d'un myélome multiple récidivant ou réfractaire, cet essai de phase III évalue l'efficacité, du point de vue de la survie sans progression, et la toxicité d'un traitement combinant pomalidomide, bortézomib et dexaméthasone, après l'échec d'un traitement par lénalidomide (durée médiane de suivi : 15,9 mois)
A shift in the treatment paradigm for multiple myeloma has taken place in recent years. The upfront strategy in transplant-eligible patients with multiple myeloma now typically includes a three-drug induction combining a proteasome inhibitor (eg, bortezomib) and an immunomodulatory drug, followed by autologous stem-cell transplantation and lenalidomide maintenance. In the non-transplant setting, continuous lenalidomide plus dexamethasone is a standard regimen and is the backbone of several three-drug combinations assessed in clinical trials (in combination with bortezomib or daratumumab). Lenalidomide is usually administered until progression; thus, newly diagnosed patients with multiple myeloma who are exposed to lenalidomide at first-line will become refractory to the drug at first relapse. To date, no data are available for the efficacy of lenalidomide-based combinations in lenalidomide-refractory patients. The current recommendations for treatment at relapse need to be redefined.
The Lancet Oncology , commentaire, 2018