title: Benefit of continuous treatment for responders with newly diagnosed multiple myeloma in the randomized FIRST trial.
abstract: The phase 3, randomized Frontline Investigation of Revlimid and Dexamethasone Versus Standard Thalidomide (FIRST) trial investigating lenalidomide plus low-dose dexamethasone until disease progression (Rd continuous) vs melphalan, prednisone and thalidomide for 12 cycles (MPT) and Rd for 18 cycles (Rd18) in transplant-ineligible patients with newly diagnosed multiple myeloma (NDMM) showed that Rd continuous prolonged progression-free survival and overall survival compared with MPT. A subanalysis of the FIRST trial was conducted to determine the benefits of Rd continuous in patients with NDMM based on depth of response. Patients randomized 1:1:1 to Rd continuous, Rd18 or MPT were divided into subgroups based on best response: complete response (CR; n=290), ⩾very good partial response (VGPR; n=679), ⩾partial response (PR; n=1 225) or ⩽stable disease (n=299). Over 13% of patients receiving Rd continuous who achieved ⩾VGPR as best response did so beyond 18 months of treatment. Rd continuous reduced the risk of progression or death by 67%, 51% and 35% vs MPT in patients with CR, ⩾VGPR and ⩾PR, respectively. Similarly, Rd continuous reduced the risk of progression or death by 61%, 54% and 38% vs Rd18 in patients with CR, ⩾VGPR and ⩾PR, respectively. In patients with CR, ⩾VGPR or ⩾PR, 4-year survival rates in the Rd continuous arm (81.1%, 73.1% or 64.6%, respectively) were higher vs MPT (70.8%, 59.8% or 57.2%, respectively) and similar vs Rd18 (76.5%, 67.7% and 62.5%, respectively). Rd continuous improved efficacy outcomes in all responding patients, including those with CR, compared with fixed duration treatment.
authors.affiliation: Tom Baker Cancer Center-University of Calgary, Calgary, Alberta, Canada.
authors.forename: N J
authors.initials: NJ
authors.lastname: Bahlis
authors.affiliation: Policlinico San Matteo Universita Di Pavia, Pavia, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Corso
authors.affiliation: Universitätsklinikum Jena Klinik für Innere Medizin II, Jena, Germany.
authors.forename: L-O
authors.initials: LO
authors.lastname: Mugge
authors.affiliation: Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Z-X
authors.initials: ZX
authors.lastname: Shen
authors.affiliation: Hôpital Charles LeMoyne, Longueuil, Canada.
authors.forename: P
authors.initials: P
authors.lastname: Desjardins
authors.affiliation: Institut Paoli Calmettes, Marseille, France.
authors.forename: A-M
authors.initials: AM
authors.lastname: Stoppa
authors.affiliation: CHRU Hôpital Sud Médecine Interne, Rennes, France.
authors.forename: O
authors.initials: O
authors.lastname: Decaux
authors.affiliation: Hôpital d'Instruction des Armées PERCY, Paris, France.
authors.forename: T
authors.initials: T
authors.lastname: de Revel
authors.affiliation: Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Granell
authors.affiliation: CHRU Hôpital du Haut Lévêque, CHU de Bordeaux, Pessac, France.
authors.forename: G
authors.initials: G
authors.lastname: Marit
authors.affiliation: Karolinska University Hospital, Huddinge, Sweden.
authors.forename: H
authors.initials: H
authors.lastname: Nahi
authors.affiliation: H. Hart Ziekenhuis Roeselare-Menen, Roeselare, Belgium.
authors.forename: H
authors.initials: H
authors.lastname: Demuynck
authors.affiliation: National Taiwan University Hospital, Taipei City, Taiwan.
authors.forename: S-Y
authors.initials: SY
authors.lastname: Huang
authors.affiliation: New Cross Hospital, Wolverhampton, UK.
authors.forename: S
authors.initials: S
authors.lastname: Basu
authors.affiliation: 21st Century Oncology, Jacksonville, FL, USA.
authors.forename: T H
authors.initials: TH
authors.lastname: Guthrie
authors.affiliation: Celgene Corporation, Summit, NJ, USA.
authors.forename: A
authors.initials: A
authors.lastname: Ervin-Haynes
authors.affiliation: Celgene Corporation, Summit, NJ, USA.
authors.forename: J
authors.initials: J
authors.lastname: Marek
authors.affiliation: Celgene Corporation, Summit, NJ, USA.
authors.forename: G
authors.initials: G
authors.lastname: Chen
authors.affiliation: Service des Maladies du Sang, Hôpital Claude Huriez, CHRU Lille, Lille, France.
authors.forename: T
authors.initials: T
authors.lastname: Facon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003907:Dexamethasone / Q000008:administration & dosage; D005260:Female; D006801:Humans; D000077269:Lenalidomide; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000473:pathology; D011241:Prednisone / Q000008:administration & dosage; D013792:Thalidomide / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D013792:Thalidomide; D003907:Dexamethasone; D000077269:Lenalidomide; D008558:Melphalan; D011241:Prednisone