Drug Combination Effective For Multiple Myeloma

Edward A. Stadtmauer, MD, Director of the Abramson Cancer Center Bone Marrow and Stem Cell Transplant Program and lead investigator from Penn, was part of the U.S. study published in the New England Journal of Medicine alongside a companion study from Europe showing similar results.

"Myeloma, also known as multiple myeloma, is a growing interest and concern of cancer clinicians and researchers," said Stadtmauer. "While most U.S. cancer diagnoses are decreasing, statistics show that the number of myeloma diagnoses is increasing, particularly in younger patients. This disturbing trend fuels the urgency to discover effective treatments to fight this disease. This study shows that this new class of drugs is a critical advance toward meeting that need."

REVLIMID® (lenalidomide) from Celgene, an oral medication which treats without the ravages of chemotherapy, is the first in a new class of medications called immunomodulatory drugs (IMiDs). It works by attacking both the cancer cell and the micro-environment in which it lives in the bone marrow, thereby stopping the cells' ability to adhere to the wall of tissues where they will grow. REVLIMID® may also inhibit cancer cells' ability to hide from the body's natural killer cells in the immune system by stopping angiogenesis -- the growth of blood vessels that penetrate into and feed cancerous tumors causing them to proliferate.

In both the US and European studies, patients for whom all previous treatments had failed were given either lenalidomide plus dexamethasone -- a potent synthetic steroid -- or dexamethasone with placebo. These trials were designed to investigate the effectiveness and safety of cyclic dosing of REVLIMID® at 25mg combined with high-does dexamethasone (HDD) compared with placebo and HDD in previously treated patients with multiple myeloma. A total of 705 patients were enrolled in 97 sites internationally.

Patients in both trials had been heavily treated prior to enrollment, many having failed three or more rounds of chemo and/or radiation therapy. In addition, more than 50 percent of patients enrolled had undergone stem cell transplantation. In these new studies REVLIMID® plus dexamethasone achieved superior results compared to dexamethasone alone regardless of the history of treatment, including the media survival of nearly three years. Such positive patient response suggests that treatment with REVLIMID® early in the course of the disease may be beneficial. These findings have caused a change in the official physician guidelines for multiple myeloma which were recently updated to add REVLIMID® as an initial treatment, instead of waiting until other treatments have failed.

In Europe and the US, REVLIMID® is being used to threat myeloma. In the US it is also approved for a pre-leukemia condition called myelodysplastic syndrome (MDS). It is also being tested in other leukemias, lymphomas, and solid tumors.

"The last five to ten years have been the most wonderful time to be a physician treating multiple myeloma, thanks to advances like lenalidomide," said Stadtmauer. "Twenty, thirty years ago, there wasn't much we could do for these patients. We couldn't really treat the disease effectively so we tried to treat the symptoms with only two or three types of chemotherapy and radiation, which of course have their own negative side-effects. Now, we have this new, highly effective class of drugs with very low side effects. Before, we hoped for a positive response in patients. Now, we expect one." Adds Stadtmauer, "Thanks to new agents like lenalidomide, we've been able to convert this disease from a killer to more of a chronic illness."

The data from these studies were published in two separate articles in the NEJM, by lead authors Donna Weber, MD, Associate Professor, Lymphoma/Myeloma of The University of Texas MD Anderson Cancer Center, and Meletios Dimopoulos, MD, Associate Professor, Department of Clinical Therapeutics at "Alexandra" Hospital, Athens, Greece.

The research was funded by Celgene. Dr. Stadtmauer does not have any financial ties to Celgene Corporation, the maker of REVLIMID®, but has received honoraria as part of an educational speaker's bureau sponsored by Celgene. Weber and Wang of the University of Texas MD Anderson Cancer Center have received grant funds and lecture fees from Celgene. These relationships are managed in accordance with M. D. Anderson's conflict-of-interest policies.

About Multiple Myeloma

Multiple myeloma is cancer of the plasma cells, the type of white blood cell present in bone marrow. Normal plasma cells are an important part of the immune system. When plasma cells grow out of control, they can produce a tumor. These tumors generally develop in the bone marrow. If there is only one tumor, it is called a plasmacytoma. The disease is called multiple myeloma because myeloma cells can occur in multiple bone marrow sites in your body.

At this time, the cause of multiple myeloma is not known. However, there appears to be several factors which increase the risk of developing multiple myeloma, such as extensive exposure to radiation, chemical resins, organic solvents, pesticides, and herbicides. There is also a herpes virus, Human Herpes Virus 8 (HHV-8), which is thought to be related to the development of multiple myeloma. People with first-degree relatives, such as a mother or brother, who have multiple myeloma, may also be at increased risk for developing the disease. However, a clear genetic mutation related to multiple myeloma has not been discovered.

The Abramson Cancer Center (ACC) of the University of Pennsylvania is a national leader in cancer research, patient care, and education. The pre-eminent position of the Cancer Center is reflected in its continuous designation as a Comprehensive Cancer Center by the National Cancer Institute for 30 years, one of 39 such Centers in the United States. The ACC is dedicated to innovative and compassionate cancer care. The clinical program, comprised of a dedicated staff of physicians, nurse practitioners, nurses, social workers, physical therapists, nutritionists and patient support specialists, currently sees over 50,000 outpatient visits, 3400 inpatient admissions, and provides over 25,000 chemotherapy treatments, and more than 65,000 radiation treatments annually.

Not only is the ACC dedicated to providing state-of-the-art cancer care, the latest forms of cancer prevention, diagnosis, and treatment are available to our patients through clinical themes that developed in the relentless pursuit to eliminate the pain and suffering from cancer. In addition, the ACC is home to the 300 research scientists who work relentlessly to determine the pathogenesis of cancer. Together, the faculty is committed to improving the prevention, diagnosis and treatment of cancer.