Lenalidomide Combination Fails to Improve Survival in Castration-Resistant Prostate Cancer

“The addition of lenalidomide to docetaxel and prednisone was associated with a significantly greater mortality rate in patients with metastatic castration-resistant prostate cancer, according to phase 3 study results.

“Daniel P. Petrylak, MD,professor of oncology and urology at Yale School of Medicine and a HemOnc Today Editorial Board member, and colleagues evaluated data from 1,046 chemotherapy-naive patients with metastatic castration-resistant prostate cancer.

“Researchers randomly assigned 525 patients to receive docetaxel and prednisone plus lenalidomide (Revlimid, Celgene). The other 521 patients received docetaxel and prednisone plus placebo.

“After a median follow-up of 8 months, 221 patients had died (lenalidomide arm, n = 129; placebo arm, n = 92). The number of deaths that occurred during treatment or within 28 days of receiving the final dose was similar in both groups (lenalidomide, n = 18; placebo, n = 13).”

R2CHOP Appears Highly Active in DLBCL

Editor’s note: This article describes the results of a clinical trial—a research study with volunteer patients. The trial tested a new treatment for newly diagnosed diffuse large B-cell lymphoma (DLBCL). The new treatment consists of a combination of chemotherapy drugs known as R-CHOP, plus a new drug called lenalidomide (aka Revlimid). R-CHOP is a standard treatment for DLBCL. The results were promising, but more research will need to be done to figure out whether the new treatment is indeed better than the old. The results also showed that adding lenalidomide might work better for a certain sub-group of patients known as the non-GCB subtype.

“The combination of lenalidomide and R-CHOP demonstrated considerable activity in patients with newly diagnosed diffuse large B-cell lymphoma, according to results of a phase 2 study.

“The development of a more effective initial therapy is essential to improve long-term outcomes of patients with diffuse large B-cell lymphoma (DLBCL), Grzegorz S. Nowakowski, MD, of the division of hematology at Mayo Clinic in Rochester, Minn., and colleagues wrote.

“Prior studies demonstrated lenalidomide (Revlimid, Celgene) has considerable single-agent activity in relapsed DLBCL. Lenalidomide also can be combined with R-CHOP — which consists of rituximab (Rituxan; Genentech, Biogen Idec), cyclophosphamide, doxorubicin, vincristine and prednisone) — to form a novel combination known as R2CHOP.

“In the current study, Nowakowski and colleagues evaluated the efficacy of R2CHOP in 60 patients with newly diagnosed DLBCL. The median age of patients was 65 years; 70% were aged older than 60 years, and 9% were aged ≥80 years.”

Bortezomib/Lenalidomide Combination Therapy Evaluated in Relapsed/Refractory Mantle Cell Lymphoma

Editor’s note: This article describes the results of a clinical trial—a research study with volunteer patients. The goal of the trial was to test the effectiveness of a mantle cell lymphoma treatment that combines the drugs bortezomib (Velcade) and lenalidomide (Revlimid). Specifically, the trial tested the treatment for patients whose cancer did not get better after previous treatments or whose cancer returned after treatment. The results of the clinical trial were “disappointing.” The combination treatment was less effective than either drug on its own.

“Although the majority of patients with mantle cell lymphoma respond to initial therapy, the duration of remission is typically short (1.5 to 3 years). Although bortezomib (Velcade) and lenalidomide (Revlimid) as single agents have been associated with response rates as high as 53% in patients with relapsed/refractory disease, Morrison et al reported an overall response rate of almost 40% with combination bortezomib/lenalidomide therapy in an article published in Leukemia & Lymphoma.

“The incidence of mantle cell lymphoma has increased dramatically over the past several decades. The median overall survival is 3 to 6 years with standard chemotherapy approaches, and fewer than 15% of patients are long-term survivors.

“Therefore, researchers continue to investigate newer therapeutic options for these patients. One such approach was the combination of bortezomib and lenalidomide, particularly in patients who experienced relapse from or were refractory to previous treatments. In the phase II CALGB 50501 trial, a team of investigators from the University of Minnesota, Duke University, Dana-Farber Cancer Institute, Ohio State University, Washington University, and Georgetown University attempted to evaluate the feasibility of combination treatment with bortezomib and lenalidomide in patients with relapsed or refractory mantle cell lymphoma.”

Chemotherapy-Free Combo Is Tested in CLL

“A novel immune-based combination therapy for the initial treatment of chronic lymphocytic leukemia (CLL) does not appear to improve on results achieved with established regimens that include chemotherapy.

“In a phase 2 study, investigators combined rituximab (Rituxan, MabThera and Roche), the monoclonal antibody widely used for CLL, and lenalidomide (Revlimid, Celgene), an immunomodulatory agent that is not approved in these patients.

“The idea behind the pairing was to avoid chemotherapy, which is generally not well tolerated by older or infirm CLL patients and is part of all regimens containing rituximab, say the investigators, led by Danelle James, MD, from the Moores Cancer Center at the University of California, San Diego.”

Editor’s note: A potential alternative to chemotherapy for chronic lymphocytic leukemia (CLL) was tested in volunteer patients, but did not show improved results over chemo. The treatment combines the drug Rituxan with another drug called Revlimid, which is meant to boost a patient’s immune system to help fight cancer. Researchers hope to test other combinations of non-chemo drugs to see if they will prove more successful.