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Repression of Multiple Myeloma Cell Growth In Vivo by Single-wall Carbon Nanotube SWCNT-delivered MALAT1 Antisense Oligos
Published on: December 13, 2018
A network meta-analysis of randomized clinical trials in lenalidomide-exposed or -refractory multiple myeloma
E A Martino1, G Caridà2, D Lofaro3
1Hematology Unit, Department of Onco-Hematology, AO of Cosenza, Cosenza, Italy.
Background:
The treatment landscape for relapsed/refractory multiple myeloma (RRMM) is rapidly evolving, particularly for patients exposed or refractory to lenalidomide. With the aim of evaluating the relative efficacy of lenalidomide-free regimens as second-line treatment options, an updated network meta-analysis, incorporating phase II/III randomized controlled trials, has been conducted.
Materials And Methods:
A systematic literature search identified eight eligible trials comprising 3952 patients. The primary outcome was progression-free survival (PFS), analyzed through Bayesian and frequentist approaches.
Results:
Our findings indicate that belantamab mafodotin, bortezomib, and dexamethasone (BVd) combination is the most effective regimen for both lenalidomide-exposed and lenalidomide-refractory MM patients at first relapse, achieving the highest surface under the cumulative ranking curve for PFS. BVd outperformed other triplet regimens, including daratumumab, bortezomib, and dexamethasone, isatuximab, carfilzomib, and dexamethasone, and bortezomib, pomalidomide, and dexamethasone.
Conclusions:
Emerging therapies, including chimeric antigen receptor T-cell (CAR-T-cell) therapy and bispecific antibodies, are set to reshape RRMM treatment paradigms. Trials such as CARTITUDE-4 and MajesTEC-3 are exploring these agents in earlier treatment lines, particularly for lenalidomide- and daratumumab-refractory patients. Our analysis provides an evidence-based hierarchy of lenalidomide-free regimens, supporting BVd as a preferred second-line treatment. Future studies should refine treatment sequencing strategies and evaluate novel agents in earlier disease stages to optimize outcomes for RRMM patients.
Insights
Belantamab mafodotin, bortezomib, and dexamethasone (BVd) is the most effective lenalidomide-free regimen for relapsed/refractory multiple myeloma (RRMM) patients. This finding supports BVd as a preferred second-line treatment option.
Area of Science:
- Hematology
- Oncology
- Clinical Trials
Background:
- Relapsed/refractory multiple myeloma (RRMM) treatment is evolving, especially for lenalidomide-exposed or refractory patients.
- Evaluating lenalidomide-free regimens is crucial for optimizing second-line treatment strategies.
- Network meta-analysis provides a robust framework for comparing diverse therapeutic options.
Purpose of the Study:
- To conduct an updated network meta-analysis of phase II/III randomized controlled trials.
- To evaluate the relative efficacy of lenalidomide-free regimens in relapsed/refractory multiple myeloma.
- To identify the most effective second-line treatment options for patients refractory to lenalidomide.
Main Methods:
- Systematic literature search identifying eight eligible randomized controlled trials.
- Inclusion of 3952 patients in the meta-analysis.
- Bayesian and frequentist approaches used to analyze progression-free survival (PFS) as the primary outcome.
Main Results:
- The belantamab mafodotin, bortezomib, and dexamethasone (BVd) combination demonstrated the highest surface under the cumulative ranking curve for PFS.
- BVd proved most effective for both lenalidomide-exposed and lenalidomide-refractory multiple myeloma patients at first relapse.
- BVd outperformed other triplet regimens, including daratumumab-based, isatuximab-based, and pomalidomide-based combinations.
Conclusions:
- BVd is identified as a preferred second-line treatment for RRMM patients, particularly those refractory to lenalidomide.
- Emerging therapies like CAR-T-cell therapy and bispecific antibodies will significantly impact future RRMM treatment paradigms.
- Further research should focus on optimizing treatment sequencing and evaluating novel agents in earlier disease stages.
