FACULTY COMMENTS
DR ORLOWSKI: The bottom line of this paper is that with MPT we
see about an 18-month improvement in median overall survival
over MP.
I would conclude that if you have a patient who is not eligible for transplant and who has a reasonably good performance status and organ function, he or she should receive either MPT or MPV because those are the most active regimens, although they are associated with an increased risk of toxicity.
With MPT in particular, the patient can have problems with thrombosis and infection, while other issues like cytopenias are less problematic or at least easier for the average hematology/ oncology practitioner to deal with. I believe that the current best combinations we have to offer are MPT, based on this paper and Hulin’s data, and MPV, based on the San Miguel paper.
DR LONIAL: MPT clearly was the winner across the board in
terms of overall survival, progression-free survival and response
rate. A little more myelosuppression, somnolence and peripheral
neuropathy were observed with MPT compared to MP alone.
The deep vein thrombosis rate was a little higher than I would
have expected, but they didn’t use any prophylaxis. I believe
this was the trial that established MPT as a standard for elderly
patients with myeloma who are not transplant eligible.
DR JAKUBOWIAK: The simple answer from the Facon study is that the addition of thalidomide to MP results in a superior response rate, progression-free survival and overall survival compared to MP alone. Secondly, there is no way to “rescue” this superiority by using reduced-intensity ASCT, with melphalan 100 mg/m2, in elderly patients. Those patients did not fare better than those treated with MP. So, to some extent, this tells us that adding a new drug to a regimen is better than escalating traditional cytotoxic drugs.
| Table of Contents | Top of Page |
