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Fouquet G, Pegourie B, Macro M, Petillon MO, Karlin L, Caillot D, Roussel M, Arnulf B, Mathiot C, Marit G, Kolb B, Stoppa AM, Brechiniac S, Richez V, Rodon P, Banos A, Wetterwald M, Garderet L, Royer B, Hulin C, Benbouker L, Decaux O, Escoffre-Barbe M, Fermand JP, Attal M, Avet-Loiseau H, Moreau P, Facon T, Leleu X. Safe and prolonged survival with long-term exposure to pomalidomide in relapsed/refractory myeloma. Ann Oncol 2016; 27:902-7. [PMID: 26787238 DOI: 10.1093/annonc/mdw017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 01/07/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The IFM2009-02 trial studied pomalidomide (4 mg daily, 21/28 versus 28/28) and dexamethasone in very advanced relapsed or refractory multiple myeloma (RRMM). We observed that 40% of patients had a prolonged progression-free survival (PFS) and subsequently overall survival (OS). We sought to analyze the characteristics of these patients and study the effect of long exposure to pomalidomide. DESIGN We separated the studied population into two groups: 3 months to 1 year (<1 year) and more than 1 year (≥1 year) of treatment with pomalidomide and dexamethasone based on clinical judgment and historical control studies. We then analyzed the characteristics of patients according to duration of treatment. RESULTS The overall response rate (ORR) for the <1-year group was 43%, the median PFS 4.6 months [95% confidence interval (95% CI) 3.8-6.4] with only 6% at 12 months, and the median OS was 15 months (11.7-20.3) and 40% at 18 months. For the ≥1-year group, the response rate and survival were strikingly different, ORR at 83%, median PFS 20.7 months (14.7-35.4), median OS not reached, and 91% at 18 months. CONCLUSION Pomalidomide and dexamethasone favored prolonged and safe exposure to treatment in 40% of heavily treated and end-stage RRMM, a paradigm shift in the natural history of RRMM characterized with a succession of shorter disease-free intervals and ultimately shorter survival. Although an optimization of pomalidomide-dexamethasone regimen is warranted in advanced RRMM, we claim that pomalidomide has proven once more to change the natural history of myeloma in this series, which should be confirmed in a larger study.
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Affiliation(s)
- G Fouquet
- Department of Blood Diseases, Hôpital Huriez, CHRU Lille, Lille
| | - B Pegourie
- Department of Hematology, Hôpital A.Michallon, CHU Grenoble, Grenoble
| | - M Macro
- Department of Hematology, Hôpital Côte de Nacre, CHU Caen, Caen
| | - M O Petillon
- Department of Blood Diseases, Hôpital Huriez, CHRU Lille, Lille
| | - L Karlin
- Department of Hematology, Centre Hospitalier Lyon-Sud, Lyon
| | - D Caillot
- Department of Hematology, CHU de Dijon, Dijon
| | - M Roussel
- Department of Hematology, CHU de Toulouse, Toulouse
| | - B Arnulf
- Department of Hematology, Hôpital Saint Louis, APHP, Paris
| | - C Mathiot
- Intergroupe Francophone du Myélome (IFM)
| | - G Marit
- Department of Hematology and Cell Therapy Service, CHU de Bordeaux, Pessac, France
| | - B Kolb
- Department of Hematology, Hôpital Robert Debré, CHU Reims, Reims
| | - A M Stoppa
- Department of Hematology, Institut Paoli Calmettes, Marseille
| | - S Brechiniac
- Department of Hematology, CHU Avicennes, APHP, Paris
| | - V Richez
- Department of Hematology, CHU Nice, Nice
| | - P Rodon
- Department of Hematology, CH de Périgueux, Périgueux
| | - A Banos
- Department of Hematology, CH de la Côte Basque, Bayonne
| | - M Wetterwald
- Department of Hematology, CH de Dunkerque, Dunkerque
| | - L Garderet
- Department of Hematology, CHU St-Antoine, Paris
| | - B Royer
- Department of Hematology, Hôpital Sud, CHU Amiens, Amiens
| | - C Hulin
- Department of Hematology, Hôpital de Nancy, Nancy
| | - L Benbouker
- Department of Hematology, Hôpital de Tours, Tours
| | - O Decaux
- Department of Hematology, CHU Rennes, Rennes
| | | | - J P Fermand
- Department of Hematology, Hôpital Saint Louis, APHP, Paris
| | - M Attal
- Department of Hematology, CHU de Toulouse, Toulouse
| | | | - P Moreau
- Department of Hematology, CHU Nantes, Nantes
| | - T Facon
- Department of Blood Diseases, Hôpital Huriez, CHRU Lille, Lille
| | - X Leleu
- Department of Hematology, CHU Poitiers, Poitiers
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Maloisel F, Dubruille V, Varet B, Escoffre-Barbe M, Berthaud P, Meresse V, Mahon F, Preudhomme C, Guilhot J, Guilhot F. Design and first interim analysis of a randomized phase III trial comparing imatinib versus imatinib (IM) based combination therapies in newly diagnosed chronic myelogenous leukemia patients in chronic phase. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.6589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6589 Background: Despite impressive results achieved with IM 400 mg/day alone, only a minority of pts reached a complete molecular remission at 12-month. Higher dose of IM or its combination with other therapies might improve molecular remission. Design of the trial: the 3 experimental arms are IM 400mg daily in combination with Peg-IFN-α2a (Peg-IFNα2a, 90 μg weekly) or with Ara-C (20 mg/m2/day, days 15–28 of 28-day cycles) or IM 600mg daily. The reference arm is IM 400mg daily. All pts (over 18 years of age with Bcr-Abl positive CML) receive IM 400 mg/day as monotherapy days 1–14 and then start the assigned regimen for at least 12 months. The endpoints are overall survival (primary), rate and duration of hematologic, cytogenetic and molecular responses and tolerability. An interim analysis of the first 636 pts at 1 year from randomization will allow evaluation of molecular response rates, one of the experimental arm being selected for further comparison with IM 400. An experimental arm would be selected if it increased the 4 log reduction response rate at 12-month by at least 20 percentage points, (15% to 35%), with an acceptable tolerability. Results: This evaluation is based on a cohort of 370 pts with a median time of observation of 16 months, recruited between 9/2003 and 9/2005. [median age 53 yrs (18–81); Sokal distribution: 38% of pts low, 38% intermediate, and 24% high]. At 1 month 80% of pts achieved complete hematologic response. At 12 months, 138 pts (72%) achieved a major cytogenetic response, being complete in 120 pts (63%). Grade 3/4 hematologic toxicity occurred in 8% of IM400 pts, 9% of IM600 pts, 41% of IM+IFN pts and 33% of IM+Ara-c pts respectively. Dose of Peg IFN was reduced in 16% of pts, 45 μg per week being well tolerated. Grade 3/4 non hematological toxicity occurred in 11% of IM400 pts, 16% of IM600 pts, 10% of IM+IFN pts (maily skin rash) and 11% of IM+Ara-c pts. Discontinuation of experimental treatment occurred in 17% of IM600 pts, 36% of IM+IFN pts and 16% of IM+Ara-c pts. Conclusion: This first analysis confirmed both feasibility of IM combinations and high response rates. However a substantial hematological toxicity requires a careful assessment of pts. [Table: see text]
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Affiliation(s)
- F. Maloisel
- Fi-Lmc; Department of Hematology, Strasbourg, France; Department of Hematology, Nantes, France; Department of Hematology, Paris, France; Department of Hematology, Rennes, France; Novartis Pharma France, Rueil-Malmaison, France; Roche Pharma, Paris, France; Laboratory of Hematology, Bordeaux, France; Laboratory of Hematology, Lille, France; Clinical Research Centre, Poitiers, France; Department of Hematology, Poitiers, France
| | - V. Dubruille
- Fi-Lmc; Department of Hematology, Strasbourg, France; Department of Hematology, Nantes, France; Department of Hematology, Paris, France; Department of Hematology, Rennes, France; Novartis Pharma France, Rueil-Malmaison, France; Roche Pharma, Paris, France; Laboratory of Hematology, Bordeaux, France; Laboratory of Hematology, Lille, France; Clinical Research Centre, Poitiers, France; Department of Hematology, Poitiers, France
| | - B. Varet
- Fi-Lmc; Department of Hematology, Strasbourg, France; Department of Hematology, Nantes, France; Department of Hematology, Paris, France; Department of Hematology, Rennes, France; Novartis Pharma France, Rueil-Malmaison, France; Roche Pharma, Paris, France; Laboratory of Hematology, Bordeaux, France; Laboratory of Hematology, Lille, France; Clinical Research Centre, Poitiers, France; Department of Hematology, Poitiers, France
| | - M. Escoffre-Barbe
- Fi-Lmc; Department of Hematology, Strasbourg, France; Department of Hematology, Nantes, France; Department of Hematology, Paris, France; Department of Hematology, Rennes, France; Novartis Pharma France, Rueil-Malmaison, France; Roche Pharma, Paris, France; Laboratory of Hematology, Bordeaux, France; Laboratory of Hematology, Lille, France; Clinical Research Centre, Poitiers, France; Department of Hematology, Poitiers, France
| | - P. Berthaud
- Fi-Lmc; Department of Hematology, Strasbourg, France; Department of Hematology, Nantes, France; Department of Hematology, Paris, France; Department of Hematology, Rennes, France; Novartis Pharma France, Rueil-Malmaison, France; Roche Pharma, Paris, France; Laboratory of Hematology, Bordeaux, France; Laboratory of Hematology, Lille, France; Clinical Research Centre, Poitiers, France; Department of Hematology, Poitiers, France
| | - V. Meresse
- Fi-Lmc; Department of Hematology, Strasbourg, France; Department of Hematology, Nantes, France; Department of Hematology, Paris, France; Department of Hematology, Rennes, France; Novartis Pharma France, Rueil-Malmaison, France; Roche Pharma, Paris, France; Laboratory of Hematology, Bordeaux, France; Laboratory of Hematology, Lille, France; Clinical Research Centre, Poitiers, France; Department of Hematology, Poitiers, France
| | - F. Mahon
- Fi-Lmc; Department of Hematology, Strasbourg, France; Department of Hematology, Nantes, France; Department of Hematology, Paris, France; Department of Hematology, Rennes, France; Novartis Pharma France, Rueil-Malmaison, France; Roche Pharma, Paris, France; Laboratory of Hematology, Bordeaux, France; Laboratory of Hematology, Lille, France; Clinical Research Centre, Poitiers, France; Department of Hematology, Poitiers, France
| | - C. Preudhomme
- Fi-Lmc; Department of Hematology, Strasbourg, France; Department of Hematology, Nantes, France; Department of Hematology, Paris, France; Department of Hematology, Rennes, France; Novartis Pharma France, Rueil-Malmaison, France; Roche Pharma, Paris, France; Laboratory of Hematology, Bordeaux, France; Laboratory of Hematology, Lille, France; Clinical Research Centre, Poitiers, France; Department of Hematology, Poitiers, France
| | - J. Guilhot
- Fi-Lmc; Department of Hematology, Strasbourg, France; Department of Hematology, Nantes, France; Department of Hematology, Paris, France; Department of Hematology, Rennes, France; Novartis Pharma France, Rueil-Malmaison, France; Roche Pharma, Paris, France; Laboratory of Hematology, Bordeaux, France; Laboratory of Hematology, Lille, France; Clinical Research Centre, Poitiers, France; Department of Hematology, Poitiers, France
| | - F. Guilhot
- Fi-Lmc; Department of Hematology, Strasbourg, France; Department of Hematology, Nantes, France; Department of Hematology, Paris, France; Department of Hematology, Rennes, France; Novartis Pharma France, Rueil-Malmaison, France; Roche Pharma, Paris, France; Laboratory of Hematology, Bordeaux, France; Laboratory of Hematology, Lille, France; Clinical Research Centre, Poitiers, France; Department of Hematology, Poitiers, France
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