Dr. Sundar Jagannath Discusses Approval of Lenalidomide in Multiple Myeloma

Sundar Jagannath, MD, director of the multiple myeloma program, professor of medicine (hematology and medical oncology), Tisch Cancer Institute at Mount Sinai School of Medicine, discusses the recent approval of lenalidomide as a therapy for patients with multiple myeloma.

Lenalidomide (Revlimid) has been approved as a treatment for newly diagnosed patients with multiple myeloma, Jagannath says. This approval was based off of results in the FIRST trial, which was an open-label phase III study. Here, treatment with continuous lenalidomide plus low-dose dexamethasone reduced the risk of disease progression by 28% compared with melphalan, prednisone, and thalidomide.

Though the FIRST trial resulted in an approval of two drug combinations, Jagannath prefers to use three drugs in a treatment with multiple myeloma. The choice of whether a physician uses two or three drugs varies according to region, Jagannath says.

Jagannath says there are two separate pathways to develop myeloma — patients with hyperdiploidy and those without it. The latter are likely to have translocations. However, it is now understood that there are 3 to 5 clones within one patient, even at the time of diagnosis. The more drugs used allows the clones to be treated more effectively, Jagannath says.

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