Continuous therapy versus fixed duration of therapy in patients with newly diagnosed multiple myeloma

Antonio Palumbo, Francesca Gay, Federica Cavallo, Francesco D. Raimondo, Alessandra Larocca, Izhar Hardan, Arnon Nagler, Maria T. Petrucci, Roman Hajek, Sara Pezzatti, Michel Delforge, Francesca Patriarca, Francesca Donato, Chiara Cerrato, Chiara Nozzoli, Zhinuan Yu, Luana Boccadifuoco, Tommaso Caravita, Giulia Benevolo, Tommasina GuglielmelliDonatella Vincelli, Christian Jacques, Meletios A. Dimopoulos, Giovannino Ciccone, Pellegrino Musto, Paolo Corradini, Michele Cavo, Mario Boccadoro

Research output: Contribution to journalArticle

Abstract

Purpose: Continuous therapy (CT) prolongs progression-free survival 1 (PFS1; time from random assignment until the first progression or death), but chemotherapy-resistant relapse may negatively impact overall survival (OS). Progression-free survival 2 (PFS2; time from random assignment until the second progression or death) may represent an additional tool to estimate outcome. This study evaluates the benefit of novel agent-based CT versus fixed duration of therapy (FDT) in patients with newly diagnosed myeloma. Methods: We included patients enrolled onto three phase III trials that randomly assigned patients to novel agent-based CT versus FDT. Primary analyses were restricted to the intent-to-treat population eligible for CT (patients progression free and alive at 1 year after random assignment). Primary end points were PFS1, PFS2, and OS. All hazard ratios (HRs) and 95% CIs were adjusted for several potential confounders using Cox models. Results: In the pooled analysis of the three trials, 604 patients were randomly assigned to CT and 614 were assigned to FDT. Median follow-up was 52 months. In the intent-to-treat CT population, CT (n = 417), compared with FDT (n = 410), significantly improved PFS1 (median, 32 v 16 months, respectively; HR, 0.47; 95% CI, 0.40 to 0.56; P <.001), PFS2 (median, 55 v 40 months, respectively; HR, 0.61; 95% CI, 0.50 to 0.75; P <.001), and OS (4-year OS, 69% v 60%, respectively; HR, 0.69; 95% CI, 0.54 to 0.88; P = .003). Conclusion: In this pooled analysis, CT significantly improved PFS1, PFS2, and OS. The improvement in PFS2 suggests that the benefit reported during first remission is not cancelled by a shorter second remission. PFS2 is a valuable end point to estimate long-term clinical benefit and should be included in future trials.

Original languageEnglish
Pages (from-to)3459-3466
Number of pages8
JournalJournal of Clinical Oncology
Volume33
Issue number30
DOIs
Publication statusPublished - Oct 20 2015

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ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

Cite this

Palumbo, A., Gay, F., Cavallo, F., Raimondo, F. D., Larocca, A., Hardan, I., Nagler, A., Petrucci, M. T., Hajek, R., Pezzatti, S., Delforge, M., Patriarca, F., Donato, F., Cerrato, C., Nozzoli, C., Yu, Z., Boccadifuoco, L., Caravita, T., Benevolo, G., ... Boccadoro, M. (2015). Continuous therapy versus fixed duration of therapy in patients with newly diagnosed multiple myeloma. Journal of Clinical Oncology, 33(30), 3459-3466. https://doi.org/10.1200/JCO.2014.60.2466