In England, the National Institute for Health and Care Excellence (NICE) has approved the use of a triple-therapy of carfilzomib with dexamethasone and lenalidomide. The therapy is recommended for use in patients who have had at least one previous therapy which included bortezomib.
Clinical trials have shown that the triple-therapy led to longer periods of remission and longer duration until death. This new second-line triple therapy could be offered to around 2,000 multiple myeloma patients, now that the organisation has evidence of its cost-effectiveness.
Meindert Boysen of NICE said: “The clinical data shows that the benefits of this triple therapy continue after treatment has stopped. A positive decision has been made possible after the company and NHS England came to a commercial arrangement which allows carfilzomib to be used on the NHS with a confidential discount.”
Separately, a study published earlier in March has suggested that some older multiple myeloma patients could be spared long-term steroid dexamethasone treatment and have equally good outcomes.
The trial was led by Dr Alessandra Larocca, of the University of Turin in Italy. The study involved 199 newly-diagnosed myeloma patients with a median age of 76, and deemed to be intermediate fitness for treatment.
They found that switching these patients to a lower dose of lenalidomide and discontinuing dexamethasone after nine months was safe and as effective as remaining on both drugs continuously.
Findings were published in the journal Blood. Dr Larocca says: “Myeloma patients are a very diverse population, including fit patients who may tolerate full-dose treatments, and intermediate-fit and frail patients who are more susceptible to adverse events.
“Our study shows, for the first time, that reducing the dose or intensity of treatment is a feasible option and produces similar outcomes as standard dose treatments for intermediate-fit patients.”
Larocca A, Bonello F, Gaidano G, D'Agostino M, Offidani M, Cascavilla N, Capra A, Benevolo G, Tosi P, Galli M, Marasca R, Giuliani N, Bernardini A, Antonioli E, Rota Scalabrini D, Cellini C, Pompa A, Monaco F, Patriarca F, Caravita T, Corradini P, Tacchetti P, Boccadoro M, Bringhen S. (2021) “Dose/Schedule-Adjusted Rd-R vs Continuous Rd for elderly, intermediate-fit, newly diagnosed multiple myeloma patients.” Blood, doi: 10.1182/blood.2020009507
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