According to a new study published in the “New England of Medicine”, patients with relapsed or refractory multiple myeloma have a better chance of survival if they received an immune-stimulating monoclonal antibody in addition to the usual treatment.
Long incurable, multiple myeloma has benefited in recent years from a significant advance in treatment, thus giving patients real hope of survival without relapse.
New research, published in the New England Journal of Medicine, again go in this direction. Conducted by the University of Athens, they highlight the benefits of combined immunotherapy in patients with relapsed or refractory multiple myeloma.
A progression-free survival rate more than 2 times higher
Indeed, say the researchers, for patients with multiple myeloma who fail treatment with lenalidomide and a proteasome inhibitor, progression-free survival is longer when they receive the immunostimulatory monoclonal antibody elotuzumab in addition to pomalidomide. and dexamethasone, compared to pomalidomide and dexamethasone alone.
Pomalidomide is an immunomodulator indicated in the management of multiple myeloma. It is indicated in combination with dexamethasone for the treatment of relapsed and refractory multiple myeloma in adult patients who have received at least two prior treatments including lenalidomide and bortezomib and whose disease progressed during the last treatment.
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A common cancer
Second most common blood cancer after leukemia, myeloma is characterized by the proliferation in the bone marrow of plasma cells, white blood cells secreting antibodies (or immunoglobulins), but the presence of which in excess leads to a decrease in other antibodies, in due to the suffocation of their producing cells in the marrow, as well as a weakening of the bone skeleton. This leads to a decrease in the normal defense antibodies against infections and an increased risk of infection.
Moreover, the overabundant presence of this monoclonal antibody, which the body does not need, leads to dysfunction of the kidneys and other organs. In some cases, these myeloma cells make only a fragment of antibody (“light chains”), or no antibody at all.
A validation study
In 2016, a phase III study already considered promising the combination of the monoclonal antibody elotuzumab, at a dose of 10 mg/kg, in combination with lenalidomide and dexamethasone. This time, researchers randomly assigned 117 patients with refractory or relapsed multiple myeloma to a first group receiving pomalidomide and dexamethasone in addition to elotuzumab (60 patients) and a second group receiving pomalidomide and dexamethasone alone (control group of 57 patients).
They then found that the median progression-free survival rate was 10.3 and 4.7 months in the elotuzumab and control groups, respectively, after a minimum follow-up period of 9.1 months. Compared to the control group, the hazard ratio for disease progression or death was 0.54 in the group that received elotuzumab. The overall response rate was 53% in patients who received elotuzumab, compared to 26% for patients in the control group.
Reduced risk of death
Overall, therefore, the risk of progression or death was significantly lower in those treated with elotuzumab in addition to pomalidomide and dexamethasone compared to those receiving only pomalidomide and dexamethasone.
In addition, grade 3 or 4 adverse effects were fewer in patients who received elotuzumab compared to those in the control group: neutropenia (13% in the elotuzumab group compared to 27% in the control group), anemia (10% versus 20%) and hyperglycemia (8% versus 7%).
“Results so far are encouraging, but extensive follow-up is needed to determine long-term efficacy and safety outcomes, including final analysis of overall survival,” the authors write. ‘study.
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