Well, there was another study released recently that showed very similar results.
As with last year's study, the new study compares melphalan, prednisone, and thalidomide, followed by thalidomide maintenance (MPT-T), to melphalan, prednisone, and Revlimid, followed by Revlimid maintenance (MPR-R), in newly diagnosed myeloma patients who are not eligible for a stem cell transplant.
The two treatment regimens provided similar response rates and similar progression-free survival. There were more cases of peripheral neuropathy in the patients treated with the thalidomide regimen, and this limited how long the thalidomide maintenance could be given. But there also were significantly more cases of low blood counts in the patients treated with the Revlimid regimen.
The researchers who wrote the study concluded:
MPR-R has no advantage over MPT-T concerning efficacy. The toxicity profile differed with clinically significant neuropathy during thalidomide maintenance versus myelosuppression with MPR.
Note that, in the study published last year, MPT-T actually led to longer overall survival than MPR-R, although the difference in overall survival was not statistically significant.
To me, these studies underscore why it's important to not just blindly accept conventional wisdom or what you hear hyped in interviews or videos. I personally try hard to focus, instead, on evidence published in peer-reviewed research studies, since it's more factual and has gone through more hoops to ensure that it's not biased.
Here's are the reference and abstract for the new study:
S Zweegman et al, "Lenalidomide plus melphalan and prednisone, followed by lenalidomide maintenance versus thalidomide plus melphalan and prednisone, followed by thalidomide maintenance; results of the randomised phase 3 HOVON 87/NMSG18 trial", Blood, January 2016 (abstract)
Abstract:
The combination of melphalan, prednisone and thalidomide (MPT) is considered standard therapy for newly diagnosed patients with multiple myeloma (NDMM) who are ineligible for stem-cell transplantation. Long term treatment with thalidomide is hampered by neurotoxicity. Melphalan, prednisone and lenalidomide, followed by lenalidomide maintenance therapy showed promising results, without severe neuropathy emerging. We randomly assigned 668 NDMM patients, ineligible for stem-cell transplantation, between nine 4-weekly cycles of MPT followed by thalidomide maintenance until disease progression or unacceptable toxicity (MPT-T) and the same MP regimen with thalidomide being replaced by lenalidomide (MPR-R). This multicenter, open-label, randomised phase 3 trial was undertaken by HOVON and the NMSG. The primary endpoint was progression-free survival (PFS). The accrual for the study was completed in October 19, 2012. 318 patients were randomly assigned to receive MPT-T and 319 MPR-R. After a median follow up of 36 months PFS with MPT-T was 20 months (95% CI 18-23 months) versus 23 months (95% CI 19-27 months) with MPR-R (HR 0.87 [0.72-1.04], p=0.12). Response rates were similar, with ≥VGPR 47% and 45% respectively. Hematological toxicity was more pronounced with MPR-R, especially grade 3 and 4 neutropenia: 64 versus 27%. Neuropathy ≥ grade 3 was significantly higher in the MPT-T arm; 16% versus 2% in MPR-R, resulting in a significant shorter duration of maintenance therapy (5 versus 17 months in MPR-R), irrespective of age. MPR-R has no advantage over MPT-T concerning efficacy. The toxicity profile differed with clinically significant neuropathy during thalidomide maintenance versus myelosuppression with MPR.
Also, here is the reference for the study published last year that also looked at MPT-T versus MPR-R:
AK Stewart et al, "Melphalan, prednisone, and thalidomide vs melphalan, prednisone, and lenalidomide (ECOG E1A06) in untreated multiple myeloma", Blood, September 2015 (abstract)
