There are valid options for the palliative intent treatment of patients with relapsed/refractory multiple myeloma (RRMM) when attempting to overcome the financial toxicity of targeted agents, according to a single-center experience in Egypt presented at the at the Annual Meeting of the Society of Hematologic Oncology (SOHO).
According to the poster presentation, RRMM is a critical medical scenario especially in transplant ineligible patients. There are new approved targeted agents (e.g., anti-CD38 monoclonal antibodies or histone deacetylase inhibitors) but these carry financial burden and cannot always be afforded.
In this study, the researchers assessed if there are other affordable treatment options for these patients that can be given with palliative intent for improving quality of life. The trial assessed response rates and toxicity of bendamustine versus melphalan plus steroids after previous treatment with bortezomib- or lenalidomide-based regimens in patients with RRMM.
One arm of the study received bendamustine as a single agent at 120 mg/m2 over two days every four weeks. The other arm received melphalan 0.1 mg/kg and prednisone 100 mg for five days every four weeks.
With a median follow-up of one year, the progression-free survival in patients assigned bendamustine was 40% compared with 20% in the melphalan arm. However, bendamustine was associated with higher rates of febrile neutropenia (40% vs. 13.3%, respectively). Melphalan was associated with higher rates of gastrointestinal upset (46.6% vs. 20%) compared with bendamustine.
“With the higher financial burden with the new targeted agents, the use of either bendamustine single agent or melphalan-steroids post-bortezomib or lenalidomide containing regimens in patients diagnosed to have RRMM remains a valid option in the context of palliative intent with acceptable toxicity profile,” the researchers concluded.