Abstract
The use of maintenance therapy demonstrated benefits only since the 1980s, since the era of targeted novel agents, especially immunomodulatory drugs (IMiDs) in multiple myeloma. Several phase 3 randomized clinical trials have showed a significant benefit of thalidomide, as maintenance therapy, in terms of remission rate, progression-free survival and overall survival. However, patients could not remain on thalidomide therapy for a long period because of occurrence of adverse events, especially related to neuropathy. The development of lenalidomide, a new IMiDs with a better tolerance profile, has encouraged the launch of 3 phase 3 trials, 2 in the posttransplant setting and the latter in elderly patients not eligible for intensification. Herein, we performed a review of the literature and summarized the preliminary results available for the 3 phase 3 randomized clinical trials.
Résumé
Depuis les années 1980, les traitements d’entretien dans le myélome multiple (MM) n’avaient pas fait la preuve d’un bénéfice. Avec l’arrivée ces dix dernières années des nouveaux agents et notamment des immunomodulateurs (IMiDs), la question du traitement d’entretien dans le MM a pu être récemment reconsidérée. De nombreux essais de phase 3 ontmontré un bénéfice de l’utilisation du thalidomide dans cette indication en termes de réponse, de survie sans progression et pour certains de survie globale. Cependant, la survenue d’effets secondaires nécessite fréquemment son arrêt prématuré. Le lénalidomide, un autre IMiD pourvu d’une meilleure tolérance clinique, est alors apparu comme le candidat idéal en traitement d’entretien dans le MM. Les résultats intermédiaires des essais de phase 3 sont encourageants. Dans cette revue de la littérature, nous discuterons les résultats des essais de phase 3 portant sur le traitement d’entretien dans le MM par thalidomide et par lénalidomide.
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Manier, S., Boyle, E., Gauthier, J. et al. Renouveau des traitements d’entretien dans le myélome multiple : place des immunomodulateurs (IMiDs). Oncologie 13, 553–558 (2011). https://doi.org/10.1007/s10269-011-2063-3
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DOI: https://doi.org/10.1007/s10269-011-2063-3