APPROXIMATELY one-quarter of patients with myeloma have numerous high-risk genetic features, making the blood cancer more aggressive, less responsive, and more likely to relapse quickly. A study by scientists at the Institute of Cancer Research, London, UK, in collaboration with the clinical trials unit at Leeds University, UK, revealed that this patient population may benefit from the drug lenalidomide, as this can reduce the chance of cancer progression or death by up to 40-fold.
Researchers suggested that patients with myeloma should be genetically tested at diagnosis, so that those most likely to benefit from lenalidomide can be identified, thereby helping to tailor treatment to the needs of each patient.
The researchers analysed data from 566 patients from the Myeloma XI trial, which aimed to evaluate the effectiveness of a range of targeted drugs, including lenalidomide, in patients with newly-diagnosed myeloma. Within this population, 51% of patients had no high-risk markers, 32% had only one high-risk genetic feature, and 17% had ‘double-hit’ myeloma, which referred to having two or more high-risk genetic features.
The research team found that some patients with ‘single-hit’ myeloma benefitted the most from lenalidomide maintenance therapy following stem cell therapy, in particular those with three distinct genetic abnormalities known as del (1p), del (17p) or t (4;14). Compared to the observation group, these patients had up to 40-fold reduced risk of cancer progression or death. Patients with single-hit myeloma lived longer on lenalidomide maintenance therapy, for an average of 57.3 months before their disease progressed, compared to 10.9 months of the observation group. Patients with double-hit or no high-risk genetic markers also benefitted from lenalidomide therapy, and demonstrated a two-fold reduced risk of disease progression or death compared to the observation group.
Martin Kaiser, study lead and team leader in Myeloma Molecular Therapy at The Institute of Cancer Research, stated: “We have found a new way to predict which patients with newly-diagnosed myeloma are most likely to benefit from the cancer drug lenalidomide after undergoing a bone marrow transplant.” The findings strongly recommend for the use of lenalidomide in patients with myeloma who have undergone a stem cell transplant, as well as the use of routine genetic testing in patients with myeloma to identify those most likely to benefit from different treatment strategies.