A new analysis of clinical trial data suggests that reducing dexamethasone doses during multiple myeloma treatment does not compromise patient survival outcomes, potentially opening the door for more tolerable treatment regimens.
The findings, published in Blood on January 2, 2025, emerge from a secondary pooled analysis of two significant clinical trials - SWOG 0777 and SWOG 1211 - conducted by researchers at Fred Hutchinson Cancer Center and collaborating institutions.
Dose Reduction Analysis and Key Findings
The research team, led by Dr. Rahul Banerjee, examined data from 541 patients with newly diagnosed multiple myeloma (NDMM) who received various treatment combinations including lenalidomide and dexamethasone, with or without bortezomib or elotuzumab. The standard dexamethasone protocol called for 40-60mg weekly doses during induction therapy.
Notably, 69% of patients (373 individuals) required dose reductions or discontinuation of dexamethasone due to grade 3 or higher toxicities. These patients, classified in the lower-dose dexamethasone (LD-DEX) group, showed comparable outcomes to those maintaining full dosing (FD-DEX).
Clinical Implications and Survival Outcomes
Statistical analysis revealed no significant differences in either progression-free survival (PFS) or overall survival (OS) between the FD-DEX and LD-DEX groups. The key factors influencing survival outcomes were:
- Treatment arm assignment
- Age 70 years or older
- Presence of thrombocytopenia
Future Directions in Multiple Myeloma Treatment
"Dexamethasone dose reductions below 40 to 60 mg per week are quite common even in the setting of clinical trials," notes Dr. Banerjee and colleagues. This observation, combined with the study's findings, suggests an opportunity to optimize treatment protocols.
The research team advocates for future clinical trials to specifically investigate lower-dose dexamethasone strategies, either from the beginning of treatment or after several cycles of therapy. This approach could potentially reduce treatment-related side effects while maintaining therapeutic efficacy.
The findings carry particular significance for clinical practice, as they suggest that necessary dose modifications due to toxicity may not compromise treatment outcomes. This could lead to more flexible and patient-friendly treatment approaches in multiple myeloma management.
