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Debate: Should CR be a treatment goal?

by Beacon Staff on Sat Feb 21, 2015 4:11 pm

We got a suggestion a while back that we might want to pass along to forum participants the published summary of a debate that took place between between Dr. Ola Landren of Sloan-Kettering and Dr. Joseph Mikhael of the Mayo Clinic.

The debate is about the following question:

Should Complete Remission, However Strictly Defined, Be the Goal for All Patients?

The debate took place at a conference last fall, but the summary wasn't published until a few weeks ago. Here is a link to the debate summary (at Oncology Times).

This is more than a theoretical debate. Many people here in the forum have asked, for example, why the number of treatment cycles for certain regimens is fixed at, say, four or six. "Why doesn't treatment go longer to get as deep a response as necessary?"

In addition, with the increasing availability of tests designed to measure minimal residual disease (MRD), there is more and more pressure on myeloma specialists to treat longer, and with more drugs at one time, so as to achieve as deep a response as possible.

Dr. Landgren argued during the debate that complete response should be a goal of treatment.

Good clinical response is important, and newer myeloma drugs provide better clinical responses. More patients are reaching deeper responses. This matters for patients. Clinical response to therapy impacts progression-free survival as well as overall survival.”

Dr. Mikhael took the opposing position,

In general, people do better with deep response. When people respond, we are happy. But we do not need to push every patient to move forward to get into strict CR.”

What are your thoughts about the debate? Do you think complete response, or even a deeper response, should be a goal of treatment?

Beacon Staff

Re: Debate: Should CR be a treatment goal?

by coachhoke on Sat Feb 21, 2015 4:46 pm

The goals, I think, for all of us are long term overall survival and good quality of life. The question is, "Is complete remission necessary to achieve these goals?"

coachhoke
Name: coachhoke
When were you/they diagnosed?: Apri 2012
Age at diagnosis: 71

Re: Debate: Should CR be a treatment goal?

by Stann on Sat Feb 21, 2015 5:30 pm

I was pushing for CR but, after 2 years of a lot of chemo and 2 transplants, my M-spike wouldn't go lower than 0.20 g/dL (2 g/L). But it's been there now for over 3 years, so low and stable has worked for me.

But I haven't tried carfilzomib (Kyprolis) or lenalidomide (Revlimid) yet, so I do wonder if I should try and push for CR now, vs waiting for relapse.

Stann
Name: Stann
Who do you know with myeloma?: Myself
When were you/they diagnosed?: 9/11/09
Age at diagnosis: 46


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