I read there is a 4% - 9% chance of developing secondary cancers when a multiple myeloma patient is treated with high dose melphalan and Revlimid.
My husband's induction therapy was Revlimid, Velcade, and dexamethasone (RVD), where he achieved a very good partial response (VGPR). He had his stem cell transplant (with high dose melphalen) and now we wait to hear his results and will have to decide on maintenance.
Is the secondary cancers due to Revlimid and melphalan when they are taken at the same time?
Any thoughts? As with everything with multiple myeloma, you never fully know if you are making the right next move.
Forums
3 posts
• Page 1 of 1
Re: Maintenance therapy and secondary cancers
Secondary cancers are mainly an issue with Revlimid maintenance. There is little or no evidence that Velcade as maintenance therapy increases the risk of secondary cancers.
If you look at data from the two main trials that have tested Revlimid as maintenance therapy after a stem cell transplant – the CALGB trial and the IFM trial – there is clearly an increased risk of secondary cancers in the patients who were on Revlimid maintenance. Yes, other studies have suggested that Revlimid increases the risk of secondary cancers the most when it is used together with melphalan. Those studies also suggest the risk of secondary cancers is not so great when Revlimid is used after melphalan, as it is when it is used together with melphalan. See, for example, this article:
"Revlimid And Secondary Cancers: Melphalan May Be The Culprit," The Myeloma Beacon, March 7, 2014
Note, though, that this is a meta analysis – an analysis of a data from many different trials, rather than just a single trial – and it's always reasonable to ask how the trials were selected for inclusion in the analysis. Was the selection objective, or could the selection process bias the results?
Personally, with two large Phase 3 studies explicitly looking at the issue of Revlimid post transplant, I would tend particularly in this case to rely more on the data from the Phase 3 studies than the meta analysis.
Results from the IFM trial haven't been presented since the ASH meeting in 2013. This ASH report discusses those results, including data about secondary cancers:
"ASH 2013 Multiple Myeloma Update - Day Three: Morning Oral Sessions," The Myeloma Beacon, Dec 13, 2013
The report also has data from the CALGB trial, which has been reporting results for a number of years. This poster from the ASCO meeting this summer has updated results of the CALGB trial, including the latest secondary cancer ("second primary malignancies") numbers (14% for patients on Revlimid maintenance, versus 6% for patients who were on the placebo).
I haven't checked closely, but I believe the ASH 2015 abstracts may have some data on this topic as well.
I know I haven't directly answered your question, but I thought I would lay out some of the relevant data to keep the discussion here focused on those results.
If you look at data from the two main trials that have tested Revlimid as maintenance therapy after a stem cell transplant – the CALGB trial and the IFM trial – there is clearly an increased risk of secondary cancers in the patients who were on Revlimid maintenance. Yes, other studies have suggested that Revlimid increases the risk of secondary cancers the most when it is used together with melphalan. Those studies also suggest the risk of secondary cancers is not so great when Revlimid is used after melphalan, as it is when it is used together with melphalan. See, for example, this article:
"Revlimid And Secondary Cancers: Melphalan May Be The Culprit," The Myeloma Beacon, March 7, 2014
Note, though, that this is a meta analysis – an analysis of a data from many different trials, rather than just a single trial – and it's always reasonable to ask how the trials were selected for inclusion in the analysis. Was the selection objective, or could the selection process bias the results?
Personally, with two large Phase 3 studies explicitly looking at the issue of Revlimid post transplant, I would tend particularly in this case to rely more on the data from the Phase 3 studies than the meta analysis.
Results from the IFM trial haven't been presented since the ASH meeting in 2013. This ASH report discusses those results, including data about secondary cancers:
"ASH 2013 Multiple Myeloma Update - Day Three: Morning Oral Sessions," The Myeloma Beacon, Dec 13, 2013
The report also has data from the CALGB trial, which has been reporting results for a number of years. This poster from the ASCO meeting this summer has updated results of the CALGB trial, including the latest secondary cancer ("second primary malignancies") numbers (14% for patients on Revlimid maintenance, versus 6% for patients who were on the placebo).
I haven't checked closely, but I believe the ASH 2015 abstracts may have some data on this topic as well.
I know I haven't directly answered your question, but I thought I would lay out some of the relevant data to keep the discussion here focused on those results.
Re: Maintenance therapy and secondary cancers
My specialist told me my secondary cancer risk would double to 7% while on Revlimid maintenance. But he suggested I do the two-year maintenance as my risk of complications with myeloma would be even worse.
-
JBarnes - Name: Jerry Barnes
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: Aug 17, 2012
- Age at diagnosis: 54
3 posts
• Page 1 of 1
Return to Treatments & Side Effects