Is It Time to Reduce Dex Dosages for Myeloma Patients?

It seems that we, myeloma patients, are tied with dexamethasone glued to our hips. I am quite certain that I am not the only one who does not recall our induction regimen (with 4 days per week of 40 mg dexamethasone) with any kind of fondness. 

In addition, dexamethasone religiously pops up with a variety of novel treatments as our disease relapses. 

So, it was that a summary of a recent clinical trial piqued my interest with the catchy title “Down with dex!” published in the most recent issue of Blood, published by the American Society of Hematology (ASH).

The article correctly points out that “dexamethasone demonstrates initial efficacy, especially at robust dosing [along the lines of 4x40 mg per week]; it also demonstrates significant and problematic toxicity over time.” 

The original article that led to this “Down with dex” commentary was part of the conclusions of two different pooled analyses in which treatment outcomes were compared with various different dosages of dexamethasone. 

Some conclusions from this polled analysis were:

• Dexamethasone dose reductions were not associated with decreased progression-free survival (PFS) or overall survival (OS).
• Less than a third of the patients in controlled clinical trials could tolerate full-dose dexamethasone.
• Novel myeloma drugs are disrupted or abandoned due to symptoms that may, in fact, be dexamethasone-induced.
• The consistent use of full-dose dexamethasone seems to be more out of habit than of efficacy. 
• More data like this is needed to change the standard-of-care dexamethasone dosage.

This study shows that reduction in the dosing of dexamethasone is possible and, as patients, we can only hope that in clinical studies going forward more emphasis will be placed on defining the optimal dose.

You can watch Dr. Banerjee’s most recent webinar on this subject and/or read the highlights here: Multiple Myeloma and Dexamethasone: Insights on Tapering, Dose Intensity, and Eye Health from New Research

Sources: 

• Down with dex! | Blood | American Society of Hematology
• Dexamethasone dose intensity does not impact outcomes in newly diagnosed multiple myeloma: a secondary SWOG analysis | Blood | American Society of Hematology