Low doses of Steroids prove effective for multiple myeloma

Lenalidomide plus low-dose dexamethasone therapy can prove to be more effective than lenalidomide plus high-dose dexamethasone for treating multiple myeloma, according to findings reported by S. Vincent Rajkumar, M.D. at the American Society of Hematology's annual meeting.

These findings were part of results of the Eastern Cooperative Oncology Group Phase III clinical trial E4A03.

Dr. Rajkumar, Mayo Clinic Cancer Center hematologist and lead investigator of the study, remarked that he was quite surprised at first to know that high doses of steroids can lead to minimized survival rates besides increasing the risk of side effects.

It will be important to note here that lenalidomide and high-dose dexamethasone, which is referred to as Rev/Dex, is presently used as a second-line treatment for myeloma.

From News-Medical.Net:

“The standard treatment for myeloma usually includes high doses of steroids such as dexamethasone. In this study we were hoping to find that a lower dose of steroids would be just as effective,” says Dr. Rajkumar, Mayo Clinic Cancer Center hematologist and lead investigator of the study. “We were surprised to find that the regimen with high-dose steroids actually was decreasing survival, besides contributing to increased side effects.”

The study compared combination treatment of oral medications lenalidomide (a novel chemotherapeutic agent) and either high- or low-dose dexamethasone (a potent steroid effective against myeloma) in 445 patients with newly diagnosed myeloma. Lenalidomide plus high-dose dexamethasone had an 18-month survival rate of 80 percent. The comparative therapy using low-dose dexamethasone showed a significantly higher 91 percent overall survival rate at 18 months, with much less toxicity.

“The lower survival rates with the high-dose dexamethasone can be attributed to disease progression as well as treatment-related toxicities,” says Dr. Rajkumar. “This is a major advance in the treatment of this cancer, and also gives researchers a new direction to explore -- that more is not necessarily better.”

The findings of this reported study are expected to offer a new paradigm before scientists who have been making every possible effort to help patients with multiple myeloma.