Lenalidomide maintenance therapy has shown strong survival results in treating newly diagnosed multiple myeloma (NDMM) based on a meta-analysis of available study results from the past 20 years that was published in JAMA Oncology.
The study researchers searched PubMed and Cochrane databases for records of phase 3 randomized trials that focused on novel agent-based maintenance treatment in NDMM from after 1999 through November 20, 2017. Comparisons were made between treatment vs placebo or no treatment, with overall survival and progression-free survival as the primary benchmarks for comparison.
The network meta-analysis of outcomes for 5073 patients included 8 treatments from 11 trials. Lenalidomide-only treatment showed the best overall survival results (HR, 0.76; 95% credible interval [CrI], 0.51-1.16). Probability of it being the best treatment was 38%.
Treatments that included lenalidomide (either alone or with prednisone) showed the best progression-free survival results (HR for lenalidomide-prednisone, 0.39, 95% CrI, 0.28-0.53; and HR for lenalidomide alone, 0.47; 95% CrI, 0.39-0.55), with a 74% probability of best treatment for lenalidomide-based options in terms of progression-free survival.
Four other maintenance treatments also showed positive progression-free survival metrics: thalidomide-interferon (HR, 0.50; 95% CrI, 0.25-1.02), thalidomide-bortezomib (HR, 0.58; 95% CrI, 0.35-0.95), bortezomib-prednisone (HR, 0.72; 95% CrI, 0.40-1.27), and thalidomide by itself (HR, 0.73; 95% CrI, 0.53-1.00). In overall survival analysis, thalidomide-bortezomib and bortezomib-prednisone also performed well (HR, 0.82; 95% CrI, 0.30-2.20; and HR, 0.84; 95% CrI, 0.25-2.80, respectively).
From this analysis, the researchers concluded that lenalidomide maintenance appears to be the best treatment option for patients with NDMM.
Gay F, Jackson G, Rosiñol L, et al. Maintenance treatment and survival in patients with myeloma: a systematic review and network meta-analysis. JAMA Oncol. 2018;4:1389-1397.