Association of response endpoints with survival outcomes in multiple myeloma
Open Access
- 19 July 2013
- journal article
- review article
- Published by Springer Science and Business Media LLC in Leukemia
- Vol. 28 (2), 258-268
- https://doi.org/10.1038/leu.2013.220
Abstract
Since the introduction of the proteasome inhibitor bortezomib and the immunomodulatory drugs (IMiDs) thalidomide and lenalidomide, more patients with multiple myeloma are achieving deep, durable responses and disease control, and are living longer. These improvements have afforded more robust analyses of the relationship between response and survival. Generally, these studies have demonstrated that improvements in the quality of response across all stages of treatment are associated with better disease control and longer survival. Thus, achievement of maximal response should be strongly considered, particularly in the frontline setting, but must also be balanced with tolerability, quality of life and patient preferences. In select patients, achievement of a lesser response may be adequate to prolong survival, and attempts to treat these patients to a deeper response may place them at unnecessary risk without significant benefit. Maintenance therapy has been shown to improve the quality of response and disease control and, in some studies, survival. Studies support maintenance therapy for high-risk patients as a standard of care, and there are emerging data supporting maintenance therapy in standard-risk patients to improve progression-free and possibly overall survival. Multidrug regimens combining a proteasome inhibitor and an IMiD have shown exceptional response outcomes with acceptable increases in toxicity in both the frontline and salvage settings, and are becoming a standard treatment approach. Moving forward, the use of immunophenotypic and molecular response criteria will be essential in better understanding the impact of highly active and continuous treatment regimens across myeloma patient populations. Future translational studies will help to develop antimyeloma agents to their fullest potential. The introduction of novel targeted therapies, including the IMiD pomalidomide and the proteasome inhibitors carfilzomib and ixazomib (MLN9708), will provide greater options to individualize treatment and help patients achieve a clinically meaningful response.Keywords
This publication has 117 references indexed in Scilit:
- Multiple myeloma: 2012 update on diagnosis, risk‐stratification, and managementAmerican Journal of Hematology, 2011
- In Vitro and In Vivo Selective Antitumor Activity of a Novel Orally Bioavailable Proteasome Inhibitor MLN9708 against Multiple Myeloma CellsClinical Cancer Research, 2011
- Criteria for diagnosis, staging, risk stratification and response assessment of multiple myelomaLeukemia, 2008
- Bortezomib plus Melphalan and Prednisone for Initial Treatment of Multiple MyelomaNew England Journal of Medicine, 2008
- VTD combination therapy with bortezomib–thalidomide–dexamethasone is highly effective in advanced and refractory multiple myelomaLeukemia, 2008
- Lenalidomide plus Dexamethasone for Relapsed Multiple Myeloma in North AmericaNew England Journal of Medicine, 2007
- Lenalidomide plus Dexamethasone for Relapsed or Refractory Multiple MyelomaNew England Journal of Medicine, 2007
- Oral melphalan and prednisone chemotherapy plus thalidomide compared with melphalan and prednisone alone in elderly patients with multiple myeloma: randomised controlled trialThe Lancet, 2006
- Bortezomib or High-Dose Dexamethasone for Relapsed Multiple MyelomaNew England Journal of Medicine, 2005
- CRITERIA FOR EVALUATING DISEASE RESPONSE AND PROGRESSION IN PATIENTS WITH MULTIPLE MYELOMA TREATED BY HIGH‐DOSE THERAPY AND HAEMOPOIETIC STEM CELL TRANSPLANTATIONBritish Journal of Haematology, 1998