title: Continuous treatment in multiple myeloma - ready for prime time?
abstract: Recently, non-genotoxic drugs have succeeded in several hematologic malignancies such as chronic myeloid leukemia (CML) or indolent non-Hodgkin's lymphomas. Unlike this, alkylating chemotherapy is still a backbone of anti-myeloma drug treatment in the vast majority of 'medically fit' subjects. With the introduction of the immunomodulatory drugs thalidomide and lenalidomide, a novel class of compounds was integrated into therapy of multiple myeloma. Either drug may be delivered for a prolonged time; however fatigue, constipation and neuropathy prevent thalidomide from serving as a 'continuous' treatment. Lenalidomide has been approved for treatment of relapsed multiple myeloma, to be delivered as a continuous therapy. Since the drug lacks thalidomide's severe side effects, it is being explored on a continuous maintenance basis both after conventional therapy and after autologous stem cell transplantation. Preliminary data of respective clinical trials that have become available show highly significant differences in event-free survival times, favoring continuous lenalidomide over placebo. Currently, it is still unclear whether this will translate also into an overall survival benefit after prolonged follow-up.
authors.affiliation: Medizinische Klinik und Poliklinik II, Schwerpunkt Hämatologie und Onkologie, Universitätsklinikum Würzburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Knop
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000633:toxicity; D017326:Clinical Trials, Phase III as Topic; D003131:Combined Modality Therapy; D003907:Dexamethasone / Q000008:administration & dosage; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D000077269:Lenalidomide; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D055502:Secondary Prevention; D013792:Thalidomide / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000633:toxicity
chemical_list: D000970:Antineoplastic Agents; D013792:Thalidomide; D003907:Dexamethasone; D000077269:Lenalidomide