Patients with Newly Diagnosed Myeloma Fare Better with Continuous Revlimid and Low-Dose Dexamethasone

In one of the largest newly diagnosed myeloma studies to date, the FIRST trial examined 1,623 participants who were randomized to receive one of three treatments: a combination of melphalan, prednisone and Thalomid (thalidomide) (MPT combination) for 12 cycles over the course of 72 weeks, a current standard of care; a combination of Revlimid (lenalidomide) and low-dose dexamethasone (RD) for 18 cycles over the course of 72 weeks; or continuous RD until disease progression. The trial included participants with newly diagnosed multiple myeloma who were either 65 years and older or who were ineligible for a stem cell transplantation. After a median follow-up of about three years, the study showed a favorable benefit for the continuous RD regimen, which reduced the risk of disease progression or death by 28 percent compared with MPT (25.5 months compared with 21.2 months).

The trial data also appears to suggest an overall survival benefit with RD. At the four-year follow-up, 59.4 percent of patients receiving continuous RD were alive compared with 51.4 percent receiving the MPT combination, but the difference is not significant, meaning the improvement in survival could be by chance. Side effects were also significantly less, with fewer incidences of secondary blood cancers, neutropenia and thrombocytopenia. The rate of peripheral neuropathy was also significantly less than with MPT. Due to the increased progression-free survival and fewer toxicities, experts predict that continuous RD will become a new standard of care in patients with newly diagnosed multiple myeloma who are ineligible for transplantation.