Some Older Adults With Multiple Myeloma Have Better Outcomes When Treated With Dexamethasone-Sparing Regimen

People who are 65 and older with cancer have different needs than younger patients. This is because older adults are more likely to have other conditions in addition to cancer. They are also more likely to have complications associated with age that can be made worse by cancer treatments. This can make managing multiple myeloma more complicated for older adults than it is for younger patients. 

Doctors and researchers are always searching for new medication regimens that could be used for patients who may not be able to receive certain treatments. A recent study published in The Lancet Oncology compared treatment regimens for older adults with newly diagnosed multiple myeloma. One treatment regimen was lenalidomide and daratumumab plus dexamethasone for only two cycles. The other regimen was lenalidomide plus dexamethasone for the entire treatment cycle. The study found that those treated with lenalidomide and daratumumab, plus two cycles of dexamethasone had better outcomes than those treated with the standard dexamethasone regimen.

What is dexamethasone?

Dexamethasone is a corticosteroid commonly used in multiple myeloma. It suppresses the immune system and inflammation.  

Dexamethasone is often used in combination with other drugs to treat myeloma because of its anti-inflammatory properties that help to stop the swelling and pain related to tumors. 

Recent research has explored different dexamethasone dosing schedules when used in combination with other medications to treat myeloma. This is because using corticosteroids long-term can cause side effects such as:

• Difficulty sleeping 
• Anxiety
• Agitation 
• Weight gain 
• Edema (swelling of the legs)
• Infection
• Hypertension
• High blood sugar

These side effects can be especially challenging in managing myeloma in older adults who have additional health problems. 

What is a sparing regimen in cancer research?

A sparing regimen refers to a treatment approach that minimizes or "spares" the use of a particular drug or therapy. Sparing regimens are usually tested to see if side effects or long-term risks associated with it can be reduced or avoided, sometimes by adding other medications to a regimen. 

Study design

This phase 3 clinical trial included patients aged 65 and older who had recently been diagnosed with multiple myeloma. The participants had measurable signs of the disease. They also needed to be considered “frail” based on standard health scores. 

There were 295 patients who were placed into one of two treatment groups. In one group, 200 patients received the dexamethasone-sparing treatment. They received lenalidomide plus daratumumab, with dexamethasone for two cycles. In the other group, 95 received the standard treatment lenalidomide plus dexamethasone. 

The primary endpoint for the study was progression-free survival. This is a measure of how long it takes for myeloma to get worse after a treatment begins.

• In the dexamethasone-sparing group, the median progression-free survival was 53.4 months. For the standard treatment group, the median progression-free survival was 22.5 months. 

Median overall survival was also higher

Overall Survival (OS) measures how long patients live after starting treatment, regardless of the cause of death. After 4 years, 68% of people who received the sparing treatment were still alive. In comparison, 48% of people who received the standard treatment were still alive after 4 years. 

Treatment side-effects and safety data

In this study, severe side effects (grade 3 or higher) happened in 89% of people who received the dexamethasone-sparing treatment and 79% of people in the standard treatment group.

The most common serious side effects were: 

• Low white blood cell counts (neutropenia), which occurred in 55% of people in the dexamethasone-sparing group compared to 24% in the control group.
• Infections, which occurred in 19% of the dexamethasone-sparing group and 21% of the control group.

What this means for patients

The study is the first clinical trial of this size that focuses specifically on older patients with other health problems who are newly diagnosed with multiple myeloma. The results showed that using lenalidomide with daratumumab, while reducing or avoiding the use of dexamethasone, worked better than the usual combination of lenalidomide and dexamethasone in improving progression-free survival and overall survival. 

To continue reading about treatment advances in myeloma, follow the link below. 

Read More Myeloma Treatment Advances

Sources:

• Lancet-Safety and efficacy of a dexamethasone-sparing regimen  
  
• ASH Study: Older Multiple Myeloma Patients can be Spared of Long-Term Steroids
• ASCO Dexamethasone-Sparing Regimen for Frail Patients With Newly Diagnosed Multiple Myeloma