Some of my fav myeloma trials relate to steroids and "less is more".
Highlight importance of independent co- operative group trials that can answer these Q's
A brief educational thread for trainees that highlights the past, present and future of steroids in myeloma!
#mmsm
Highlight importance of independent co- operative group trials that can answer these Q's
A brief educational thread for trainees that highlights the past, present and future of steroids in myeloma!
#mmsm
Trial 1 by the ECOG Group:
ncbi.nlm.nih.gov/pmc/articles/P…
Len+high dose dex (40mg for four days of the week) vs len+low dose dex (40mg once a week) for new dx MM
Despite slightly ⬆️response rate-⬆️toxicity and deaths with high-dose dex.
Established that lower dose steroids better!
ncbi.nlm.nih.gov/pmc/articles/P…
Len+high dose dex (40mg for four days of the week) vs len+low dose dex (40mg once a week) for new dx MM
Despite slightly ⬆️response rate-⬆️toxicity and deaths with high-dose dex.
Established that lower dose steroids better!
What else can we learn from this (amongst many lessons)?
⭐️Relying exclusively on response rates in a single arm trial can miss the bigger picture- it takes randomization with a parallel cohort of patients to assess for competing risks such as treatment related mortality!
⭐️Relying exclusively on response rates in a single arm trial can miss the bigger picture- it takes randomization with a parallel cohort of patients to assess for competing risks such as treatment related mortality!
Trial 2: Continuous len/dex vs dose attenuated len dex (len⬇️to 10mg and steroids dropped after 9 cycles) by Italian group
This trial enrolled intermediate-fit pts and using composite end-point of event free survival (that included tox) showed less is more! PFS no worse either!
This trial enrolled intermediate-fit pts and using composite end-point of event free survival (that included tox) showed less is more! PFS no worse either!
Link to this trial:
ashpublications.org/blood/article/…
So what have these two trials taught us? That we can get by with lower dose of steroids, as well as less duration.
Whats the next step then?
ashpublications.org/blood/article/…
So what have these two trials taught us? That we can get by with lower dose of steroids, as well as less duration.
Whats the next step then?
The IFM group at ASH 22 presented their work on len/dex versus dara/len for frail patients with newly diagnosed MM. A complete steroid free approach, in a frail population with median age enrolled over 80!
Link to abstract:
ashpublications.org/blood/article/…
Results presented at ASH22 were immature with PFS (which was primary endpoint) not shown. But it seems that response rates were better with dara/dex.
Adverse event profile differed btwn the two arms, worse heme toxicity with dara-len
ashpublications.org/blood/article/…
Results presented at ASH22 were immature with PFS (which was primary endpoint) not shown. But it seems that response rates were better with dara/dex.
Adverse event profile differed btwn the two arms, worse heme toxicity with dara-len
Quality of life differences between the two arms not known (Very important Q!) but I do think that most patients would prefer as less of steroids as possible!
What are unmet needs of steroid dosing in myeloma?
What are unmet needs of steroid dosing in myeloma?
Many of these trials have been done in non-transplant situations in elderly patients with len/dex backbones.
Can we also quickly dose reduce steroids in other situations? (Many of us already do!)
Can we drop steroids even quicker than nine cycles? (Many of us do so already)
Can we also quickly dose reduce steroids in other situations? (Many of us already do!)
Can we drop steroids even quicker than nine cycles? (Many of us do so already)
This thread hopefully summarizes the evolution of steroid dosages through three randomized trials in myeloma! And highlights that less is often more!
END
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Dara/len* not dara dex
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