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The 23rd Congress of the European Hematology Association (EHA) took place in Stockholm from 14–17 June 2018. On Saturday 16 June, an oral session took place during which, Paul G. Richardson from the Dana-Farber Cancer Institute (DFCI), Boston, USA, presented final data from the phase III OPTIMISMM trial. This study assessed the efficacy of pomalidomide (P), bortezomib (V) and low-dose dexamethasone (d) in comparison to the efficacy of Vd alone, in lenalidomide-exposed patients that had received 1–3 prior therapies.
Pomalidomide is an oral immunomodulatory drug (IMiD) which prevented proliferation of lenalidomide-resistant cells in pre-clinical assays. It is currently approved as a treatment for relapsed and refractory multiple myeloma (RRMM) patients that have received more than two prior regimens which include both lenalidomide and bortezomib, and who progressed on the last therapy. Since lenalidomide is an established upfront therapy, patients that become refractory to lenalidomide require other options, therefore the OPTIMISMM study sought to establish the efficacy of PVd in this patient population, with the primary endpoints of progression-free survival (PFS) and safety.
Data is given as PVd treatment arm vs Vd treatment arm:
Treatment with PVd reduced the risk of progression or death by 39%, compared to treatment with Vd alone, with this benefit consistent among patient subgroups, with the greatest benefit seen in patients that had received only one prior line of therapy. This study looked exclusively at lenalidomide-exposed patients, 75% of them refractory to lenalidomide, and therefore addresses the needs of a growing patient population for whom lenalidomide is no longer an option.
“ This trial establishes the real world value of a pomalidomide and a proteasome-inhibitor based approach after lenalidomide-based therapy fails a patient, and in particular in the early relapse setting.”
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