The results of a Greek analysis show that elderly multiple myeloma patients do not respond as well to treatment as their younger counterparts. However, the results also show that novel agents extend the overall survival of elderly myeloma patients compared to conventional chemotherapy.

The Greek researchers point out that their analysis was retrospective in nature and that controlled clinical trials targeting the elderly population are necessary to properly assess their response to novel agents such as Velcade (bortezomib), thalidomide (Thalomid), and Revlimid (lenalidomide).

According to Dr. Ravi Vij of the Washington University School of Medicine, who was not involved with the study, the results are not surprising.

“Improvement in survival of patients with myeloma has been most marked in younger patients,” said Dr. Vij.

Multiple myeloma primarily affects the elderly, and, according to the Greek researchers, it is becoming increasingly common to treat patients aged 80 years or older. However, patients in this age range (octogenarians) are usually excluded from clinical trials due to poor overall health, socioeconomic reasons, or presence of other diseases. Consequently, there is currently limited data on treatment outcomes for this population.

”These patients are not candidates for aggressive therapies like stem cell transplantation and often even conventional therapeutic agents have to be dose-modified for use,” said Dr. Vij.

Researchers at the University of Athens School of Medicine inGreecesought to evaluate the characteristics of octogenarians and treatment outcomes in this patient population.

They retrospectively evaluated data from 682 newly diagnosed myeloma patients who began treatment between 2003 and 2010. Of these patients, 23 percent were 80 years of age or older.

Compared to younger patients, the octogenarians demonstrated advanced stages of disease, a higher rate of anemia, and overall poorer health.

Half of the octogenarians received novel agents as an initial line of therapy, compared to two-thirds of the younger population.  Thirty-four percent of the octogenarians were treated with a thalidomide-based regimen, 6 percent with a Velcade-based regimen, and 9 percent with a Revlimid-based regimen.

A little more than half of the octogenarians (58 percent) responded to treatment, compared three-quarters (78 percent) of patients below age 80. Among the octogenarians, those who received novel agents as initial therapy reached a higher response rate (68 percent) than those treated with more conventional methods, such as melphalan (Alkeran) plus prednisone (47 percent).

The median overall survival of the octogenarian group was 22 months, while this measure for the younger group was 46 months. Octogenarians who received initial treatment with novel agents had a median overall survival of 26 months versus 17 months for those who received a different form of treatment.

The corresponding survival outcomes were 28 months for those who received thalidomide-based therapy, 27 months for Velcade-based therapy, and 19 months for Revlimid-based therapy.

Additionally, older patients who responded to initial therapy demonstrated a longer overall survival of 29 months, compared to 16 months for those who did not respond to therapy.

Fourteen percent of octogenarians died within two months of starting treatment, compared to 3 percent of patients below age 80.

For more information, please see the study in the European Journal of Haematology. (abstract).