Secondary Malignancies Update From IMW

Submitted by Medical Director on Fri, 05/06/2011 - 09:38

A special session was added to the 13th IMW in response to the recently observed rise in incidence of secondary malignancies in patients who have been treated for MM, especially those that have received long term maintenance therapy with IMids. This is an emerging issue in several clinical trials, including trials from the French and Italian groups.  There were not a lot of answers, but rather more questions. Pooled patient analyses from several trials were presented, as well as subset analysis of others.  The bottom line is: longer term follow up is needed. 

One of the more important remaining questions to be answered is why? While all agreed with the fact that there is a higher incidence of secondary malignancies in this population, there was little consensus among the panel discussion that followed regarding how to respond.  Dr. Palumbo from the Italian group was straightforward with his opinion: “there is no concern.”  His reasoning is that there is a much higher risk of progression (a tenfold increase) than there is of developing a secondary malignancy… the benefits of IMid therapy far outweigh the risk of secondary malignancies. The incidence of secondary malignancies in patients receiving IMiD therapy is no greater than that found in the general population. 

Others were not as convinced, with the French group stopping all maintenance lenalidomide in their trials, as most patients have already had three or more years of therapy.  They want to continue to analyze the data before making any recommendations. 

There was agreement that in the community individualized treatment strategies should be made on a per patient basis. The use of Lenalidomide maintenance should continue in certain high-risk patients, with the understanding that risks of secondary malignancies are real and apparent. All patients should be closely monitored. 

The workshop is winding down today, and it was an exciting week of data, discussion, and debate.  All of the most exciting information will be summarized in the upcoming Faculty Perspective Series.