Episode 44. Maintenance Therapy in Multiple Myeloma with Dr. Hira Mian and Dr. Manni Mohyuddin
May 1, 2024
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Experts Dr. Hira Mian and Dr. Manni Mohyuddin discuss maintenance therapy in multiple myeloma, exploring studies like Meta-analysis of CALGB, Myeloma XI RCT, Canadian real-world data, and more. They analyze trials like FORTE and ATLAS, debating options for high-risk patients and emphasizing personalized treatment approaches.
Maintenance therapy in multiple myeloma aims to improve overall survival post-induction therapy.
Lenalidomide has become a standard maintenance therapy with proven benefits in progression-free survival.
Decisions on maintenance therapy consider balancing therapeutic benefits with potential toxicities and evolving treatment options.
Deep dives
Philosophy of Maintenance Therapy in Multiple Myeloma
Philosophically, maintenance therapy in multiple myeloma aims to provide ongoing treatment to keep the disease under control after initial induction therapy. The ultimate goal of maintenance therapy is to improve overall survival and change the course of the disease. This approach involves considering the long-term impact of therapy, ensuring it is worth the potential toxicity, financial costs, and physical impact on patients.
Historical Overview of Maintenance Therapy in Multiple Myeloma
Historically, maintenance therapy in multiple myeloma has evolved from early trials using agents like interferon and thalidomide to more recent standard treatments like lenalidomide. Past studies explored various agents for maintenance, highlighting the importance of prolonged treatment to prolong remission periods. Early trials often faced challenges with toxicity and lacked consistent overall survival benefits, leading to the establishment of lenalidomide as a standard maintenance therapy.
Key Trials Establishing Lenalidomide Maintenance
Trials like the CALGB and IFM trials have established lenalidomide as a standard maintenance therapy post-transplant in multiple myeloma. These trials showed a significant progression-free survival benefit with lenalidomide maintenance compared to observation or placebo. The meta-analysis combining data from these trials highlighted improved median progression-free survival rates and overall survival benefits with lenalidomide maintenance, particularly in high-risk patients.
Challenges and Considerations in Maintenance Therapy Decisions
Deciding on maintenance therapy in multiple myeloma involves evaluating the balance between therapeutic benefits and potential toxicities. The selection of maintenance strategies, including doublet or triplet regimens, is influenced by patient risk factors, treatment response, and ongoing clinical trials. Questions around the duration of maintenance and the role of novel agents highlight the evolving landscape of personalized treatment in myeloma.
Future Directions in Maintenance Therapy for Multiple Myeloma
The future of maintenance therapy in multiple myeloma emphasizes personalized approaches based on risk factors, response to induction therapy, and patient preferences. Emerging treatments like bi-specific antibodies offer new possibilities in the maintenance space, potentially shifting the focus from overall survival outcomes to progression-free survival and minimal residual disease negativity. Academic trials and ongoing research will likely shape the future of maintenance therapy, aiming for tailored interventions that optimize long-term outcomes for myeloma patients.
In this episode, we dive into the data on maintenance therapy in multiple myeloma with Dr. Hira Mian and Dr. Manni Mohyuddin. Here are the key studies we discussed:
1. Meta-analysis of individual patient-level data from CALGB, IFM, and Italian maintenance RCTs (lenalidomide vs placebo or observation):
