At the XII International Myeloma Workshop held last month, physicians discussed induction therapy for patients who are not eligible for stem cell transplants.

Induction therapy is the initial treatment given to patients to reduce the number of cancer cells, usually given prior to subsequent treatments. For patients ineligible for transplants, such as the elderly, induction therapy has historically consisted of administering the drugs melphalan and prednisone, but this has changed considerably in recent years.

A number of clinical trials have investigated the combination of melphalan and prednisone with novel agents such as thalidomide (Thalomid), Revlimid (lenalidomide), or Velcade (bortezomib).

Two studies have shown that melphalan and prednisone in combination with thalidomide lead to significant improvements in progression-free survival and overall survival. Three other trials also demonstrate improvements in overall survival.

A study investigating melphalan and prednisone in combination with Revlimid has shown a complete response rate of 30 percent. Improvements in both progression-free and overall survival were also seen.

Finally, trials exploring the combination of melphalan and prednisone with thalidomide and Velcade, as well as other combinations involving Velcade, are ongoing. Early findings from one study, for example, suggest that decreasing Velcade dosage frequency may reduce the risk of neuropathy as a side effect without sacrificing efficacy.

Physicians Sagar Lonial, MD, and Sundar Jagannath, MD, agree that the current standard of care for induction therapy for non-transplant patients is melphalan and prednisone plus a novel agent. However, an emerging alternative is Revlimid and low dose dexamethasone, a combination that has been shown to particularly benefit elderly patients.

Nevertheless, these studies are still in early stages. Jagannath concludes this discussion by urging patients to consider enrolling in clinical trials, as this is what allows the development of effective treatments to move forward.

For further information, see the IMW presentation transcript (pdf) provided by the MMRF.