FACULTY COMMENTS
DR ORLOWSKI: With the melphalan/prednisone and thalidomide
(MPT) regimen, one of the things that we would like to improve
upon is the toxicity profile. Thalidomide is not an easy drug to
administer to older patients who may have problems like constipation,
sedation, thrombosis and infection. The feeling is that
lenalidomide will be better tolerated overall.
This study had a Phase I component, which determined appropriate doses. Then a Phase II component examined the impact. At the dose levels that were ultimately recommended for further therapy, MP with lenalidomide had a 100 percent response rate with minor responses or better. It is complicated by more hematologic toxicity than MPT, but those toxicities are probably a little easier to deal with.
This trial in part is the basis for one current Intergroup study in the US, which is comparing MPT versus MPR.
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