Recently Diagnosed or Relapsed? Stop Looking For a Miracle Cure, and Use Evidence-Based Therapies To Enhance Your Treatment and Prolong Your Remission
Multiple Myeloma an incurable disease, but I have spent the last 25 years in remission using a blend of conventional oncology and evidence-based nutrition, supplementation, and lifestyle therapies from peer-reviewed studies that your oncologist probably hasn't told you about.
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Frail/Elderly Myeloma Induction
The study linked below talks about a clinical trial exclusively for frail/elderly myeloma induction therapy. Considering that MM is a blood cancer of older people, I think this info is noteworthy.
First and foremost, it is important to understand that the “elderly” MM patient, meaning, that newly diagnosed MM patient over the age of 75, is more prone to adverse events aka side effects, compared to younger patients.
Not only are side effects difficult to manage but they can cause the patient to discontinue treatment.
Like most clinical trials, the one below focuses on overall response. And that’s fine. But what about the elderly MM patient who focuses on:
- Controlling his/her MM and
- Quality of life?
In other words, what treatment regimen can control myeloma with the fewest side effects possible Consider low dose revlimid with low or even no dose of dexamethasone. I say this because low doses of both revlimid and dexamethasone have been shown to control MM rather than try to aggressively treat it.
This is the heart of the cure vs. control debate-
Elderly treatment plan, dosing, side effects- quality of life
So needless to say, I think it is important to balance quality with quantity of life when treating multiple myeloma.
Email me at David.PeopleBeatingCancer@gmail.com with your questions about both conventional and non-conventional myeloma therapies.
Thank you,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Study: Older Multiple Myeloma Patients can be Spared of Long-Term Steroids
“The combination of cancer therapy lenalidomide plus the steroid dexamethasone (together called Rd) is considered standard treatment for elderly patients with multiple myeloma. However, prolonged steroid use can be harmful for some older adults.
A new study published in Blood found that switching select older patients to a lower dose of lenalidomide and discontinuing dexamethasone after nine months was not only safe, but it also yielded similar outcomes as compared with patients who received continuous Rd…
A Dexamethasone Sparing-Regimen with Daratumumab and Lenalidomide for Frail Patients with Newly-Diagnosed Multiple Myeloma
“Background. Elderly patients with newly diagnosed multiple myeloma (NDMM) have heterogeneous fitness and disparate tolerance to treatment. Frail patients develop more adverse events leading to higher rates of treatment discontinuation.
The use of long term dexamethasone is associated with multiple side effects specially in elderly frail patients. In the phase 3 IFM2017-03 trial (NCT03993912) we investigate the efficacy and safety of daratumumab lenalidomide (DR) without long term dexamethasone to lenalidomide dexamethasone (Rd) in a frail population of patients with NDMM…
Results. In total, 295 patients were randomized (200 in DR arm and 95 in Rd arm). Median age was 81 years (range 68-92) with 84% of patients over the age of 75 years and 61% over the age of 80 years.
Baseline demographics and disease characteristics were well balanced between arms. At data cut-of, with a median follow-up time of 40 months (95%CI, 38.5 – 41.7), 79 (42%) and 16 (17%) patients in DR and Rd arms were still on treatment, respectively.
Median treatment duration was 34.5 months (95%CI, 28.3 – 40.9) in arm DR and 14.3 months (95%CI, 10.8 – 20.6) in arm Rd.
Overall best response rates were 92% in DR and 85% in Rd arms (p=0.025).
Median PFS was 48.5 months (95%CI, 35,1-NR) in DR arm vs. 21.5 months (95%CI, 16.2-36.0) in Rd arm, HR 0.51 (95%CI, 0.37-0.71), log-rank p<0.0001 (Figure 1). PFS benefit was consistent across all subgroups defined by age, ECOG, Charlson, ISS, cytogenetics and creatinine clearance.
Median OS was not reached in DR (95%CI, 53.4-NR) vs. 36.0 months in Rd, HR 0.46 (95%CI, 0.31–0.69), log-rank p=0.0001. At least one AE (grade ≥ 3) occurred in 88% and 77% of patients in DR and Rd arms, respectively.
Patients in DR group had more grade ≥ 3 hematologic AE with neutropenia (DR 62%, Rd 33%) but similar grade ≥ 3 infections, with 18% in DR and 19% in Rd arms. Among patients with infections, 5% in DR and 7% in Rd had a pneumonia.
Discontinuations due to AEs were similar in both arms (28% in DR and 34% in Rd). Baseline health-related quality of life (HRQoL) were well balanced between the 2 arms. The DR group had significantly shorter times to clinically meaningful improvement than Rd group in all QLQ-C30 domains.
Conclusion. The IFM2017-03 trial is the first phase 3 study dedicated to frail patients. It shows a significant reduced risk of progression or death by 49% in DR (dexamethasone-sparing regimen) vs. Rd, with a favorable safety profile and an improved HRQoL.”
frail/elderly myeloma induction frail/elderly myeloma induction