Friday, June 26, 2015

Bortezomib-based Combination, e.g. VMP, Probably the Most Efficient Regimen for Elderly Patients with Multiple Myeloma in Europe--Dr. Maria-Victoria Mateos's Interview at EHA 2015

María-Victoria Mateos, MD, PhD
University Hospital of Salamanca/IBSAL, Salamanca, Spain

Source: Oncology Frontier(
肿瘤瞭望)

Oncology Frontier(肿瘤瞭望): Multiple Myeloma's median incidence age is around 70, and age is an important prognostic factor, would you use a cutoff age, like 70, to determine whether on Chemo therapy? 


Dr. Mateos: I don't think so.

Multiple Myeloma usually affects the elderly population and as you said, the median age for Multiple Myeloma at diagnosis is around 75 years old, over 70.  So all patients, regardless of age can receive an appropriate chemotherapy.

The problem is that we have to evaluate the biological and chronological age of comorbidities and the performance status to identify which is the best option for therapy according to the patient’s frailty status.

But generally, all myeloma patients can be potential candidates to receive effective combinations of therapy.
  

Is there a Multiple Myeloma in elderly frailty status evaluation tool for Chemo therapy?


Dr. Mateos: The answer is definitely yes.

It is necessary when we have a patient with myeloma in front of us older than 65 or 70 to evaluate the patient’s frailty status. We have to identify whether the patient is fit, unfit or frail so we can modify the chemotherapy regimen according to this frailty status.

I can explain this with a very simple example. Fit elderly patients can receive Dexamethasone 40 mg weekly,but if unfit,should probably receive 20 mg weekly. If the patient is frail,Dexamethasone should probably not be given and should be replaced by Prednisone.

This is what we have to do with all new agents that we are incorporating into the treatment of Multiple Myeloma including Bortezomib, Thalidomide and Lenalidomide and so on, to optimize the treatment according to the frailty status.
  

Will Lenalidomide+Dexamethasone regimen replace traditional Melphalan+Prednisone regimen in the treatment of Multiple Myeloma in Eldly?    


Dr. Mateos: Lenalidomide is certainly better than Melphalan plus Prednisone because Lenalidomide is an immunomodulatory agent and in combination with low-dose Dexamethasone has continued to demonstrate superiority to the MP combination (Melphalan plus Prednisone plus Thalidomide) in the first trial.

In our Spanish trial where we compared VMP with VTP, our conclusion was that VMP was superior to VTP. So Melphalan was superior to Thalidomide.

However, in the comparator arm there was Thalidomide but no Lenalidomide, so I think that the most efficient regimen for elderly patients with Multiple Myeloma is probably the Bortezomib-based combination and here in Europe, VMP is one of them.

The other most efficient regimen to be used in elderly patients is Lenalidomide with low-dose Dexamethasone.

We can put these together in a sequential or alternating approach for fit elderly myeloma patients to really try to improve progression-free survival and overall survival.

Can Anthracyclines be used for elderly Multiple Myeloma  patients?


Dr. Mateos: Anthracyclines are effective in the treatment of Multiple Myeloma patients. However, we have to be careful with some issues particularly the cardiac toxicity of Anthracyclines in all patients but specifically in elderly patients with multiple myeloma.

Can we use it? Yes. But considering that we now have other possibilities that avoid the use of Anthracyclines and the cardiac side effect profile and consequent cardiac events, why would we?

In summary, we can use the Anthracyclines, but there are other possibilities that are equally effective without the potential cardiac side effect issues.

Reference:

[EHA访谈] 老年性多发性骨髓瘤的治疗选择  2015/6/18  肿瘤瞭望 Video Wechat

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