[Nancy Shamanna]

Re: Maintenance therapy - will it select for resistance?

by Nancy Shamanna on Sun May 11, 2014 12:45 pm

Dear Dr. Voorhees and All,

Have you seen this abstract from ASH 2013?

GEM2010MAS65: Sequential versus Alternating VMP and Rd for Newly Diagnosed Multiple Myeloma

Mateos MV et al. Comparison of sequential vs alternating administration of bortezomib, melphalan and prednisone (VMP) and lenalidomide plus dexamethasone (Rd) in elderly patients with newly diagnosed multiple myeloma (multiple myeloma): GEM2010MAS65 trial. Proc ASH 2013;Abstract 403.

At a talk presented by Dr. X. Leleu, in Edmonton last weekend, he showed us this intriguing study. Cycles of MPV were alternated with cycles of Revlimid/dex. This was compared to a sequential schema of the two drug combos. Interesting comparisons are made, and in at least one instance, the alternating schema worked better (but not in all instances).

[Multibilly]

Re: Maintenance therapy - will it select for resistance?

by Multibilly on Sun May 11, 2014 1:57 pm

Nice pick up Nancy.

Here's a pretty-easy-to-understand summary of the study Nancy references:

http://www.healio.com/hematology-oncology/highlights-from-ash-2013/alternating-sequential-combination-drug-administration-feasible-in-elderly-with-multiple-myeloma

Here's the more technical abstract:

https://myelomabeacon.org/resources/mtgs/ash2013/abs/403/

I guess the concept that Stann suggested isn't new in multiple myeloma circles and was being considered and experimented with at least as far back as 1990. This failed Italian study shows that it obviously makes a difference on which drugs you choose to alternate.

http://www.haematologica.org/content/87/9/934.long

http://informahealthcare.com/doi/abs/10.3109/10428199209058671

[Beacon Staff]

Re: Maintenance therapy - will it select for resistance?

by Beacon Staff on Sun May 11, 2014 2:33 pm

For what it's worth, the study that Nancy referenced was also mentioned in a Beacon ASH 2013 update.

ASH 2013 Multiple Myeloma Update – Day Three: Morning Oral Sessions
(see the section "Treatment Options For Newly Diagnosed Myeloma")

[Nancy Shamanna]

Re: Maintenance therapy - will it select for resistance?

by Nancy Shamanna on Mon May 12, 2014 8:57 am

Thanks Multibilly and Beacon Staff for following up on the study I referred to.

I think that the older study from 1990 used earlier drugs, not as effective as the ones used in the Spanish study. Maybe part of the relevance of this study is that it uses bortezomib [Velcade] and Revlimid sequentially. In my country, these two drugs presently are not used together, as far as I know (i.e. RVD is not approved as a 'triplet' here for first line therapy). It may well be the same in some of the European countries.

The effect of having alternating therapy may be somehow similar to having the therapies combined. I guess that could be an advantage, although the OS did not seem to improve between the alternating and sequential therapies. This is something I have wondered about, since I have had both the therapies, but not combined, and also sequentially.