EHA 2018: OPTIMISMM

Professor Paul Richardson (Boston, USA) presented the results of the OPTIMISMM study which compared the efficacy of pomalidomide, bortezomib and dexamethasone (PVd) with bortezombib and dexamethasone alone (Vd) in MM patients with 1-3 prior lines of therapy and a minimum of two cycles of lenalidomide treatment.

Author: Maria Dalby. Interviewer: Esther Drain.

Professor Paul G. Richardson (Boston) provides an update on data coming from the OPTIMISMM study

A total of 281 patients were randomised to the PVd arm and 278 in the Vd arm; 71% and 69% of patients, respectively, in the two arms had lenalidomide-refractory disease. After a median follow up of 16 months, the risk of disease progression or death was reduced by 39% in the PVd arm compared with Vd (HR=0.61; 95% CI 0.49, 0.77; p<0.0001). The overall response rate was 82.2% in the PVd arm versus 50.0% in the Vd arm; 52.7% versus 18.3% of patients, respectively achieved VGPR. Median PFS was 11.2 months in the PVd arm and 7.1 months in the Vd arm; among patients who had received only one prior line of therapy median PFS was 20.7 and 11.6 months, respectively. Safety was manageable and consistent with established profiles and the investigators concluded that PVd resulted in a significant and clinically meaningful PFS improvement in lenalidomide-exposed RRMM patients.

First-line therapy had no significant impact on OS or PFS. The only clinically meaningful TFI was noted after following first-line therapy, which led the investigators to conclude that a continuous therapeutic approach with manageable toxicities may be more appropriate in transplant ineligible MM patients. (abstract S847).

Dr Karthik Ramasamy (Oxford) gives his thoughts on what to do with lenalidomide refractory patients at relapse