Association of response endpoints with survival outcomes in multiple myeloma.
Association of response endpoints with survival outcomes in multiple myeloma.
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作者：
自从引入蛋白酶体抑制剂硼替佐米和免疫调节药物 (IMiD) 沙利度胺和来那度胺以来，越来越多的多发性骨髓瘤患者获得了深度、持久的缓解和疾病控制，并且寿命更长。这些改进为反应和生存之间的关系提供了更可靠的分析。一般来说，这些研究表明，治疗各个阶段反应质量的提高与更好的疾病控制和更长的生存期相关。因此，应重点考虑实现最大反应，特别是在一线环境中，但也必须与耐受性、生活质量和患者偏好相平衡。在某些患者中，获得较低的反应可能足以延长生存期，而尝试治疗这些患者以获得更深的反应可能会使他们面临不必要的风险，而没有显着的益处。维持治疗已被证明可以提高反应质量和疾病控制，在一些研究中还可以提高生存率。研究支持对高危患者进行维持治疗作为护理标准，并且有新的数据支持对标准风险患者进行维持治疗，以提高无进展生存率和可能的总生存率。蛋白酶体抑制剂和 IMiD 相结合的多药治疗方案在前线和抢救环境中显示出优异的反应结果和可接受的毒性增加，并且正在成为一种标准治疗方法。展望未来，免疫表型和分子反应标准的使用对于更好地了解高度活跃和持续的治疗方案对骨髓瘤患者群体的影响至关重要。未来的转化研究将有助于开发抗骨髓瘤药物，以充分发挥其潜力。新型靶向疗法的推出，包括 IMiD 泊马度胺以及蛋白酶体抑制剂卡非佐米和伊沙佐米 (MLN9708)，将为个体化治疗提供更多选择，并帮助患者获得有临床意义的缓解。
Since the introduction of the proteasome inhibitor bortezomib and the immunomodulatory drugs (IMiDs) thalidomide and lenalidomide, more patients with multiple myeloma are achieving deep, durable responses and disease control, and are living longer. These improvements have afforded more robust analyses of the relationship between response and survival. Generally, these studies have demonstrated that improvements in the quality of response across all stages of treatment are associated with better disease control and longer survival. Thus, achievement of maximal response should be strongly considered, particularly in the frontline setting, but must also be balanced with tolerability, quality of life and patient preferences. In select patients, achievement of a lesser response may be adequate to prolong survival, and attempts to treat these patients to a deeper response may place them at unnecessary risk without significant benefit. Maintenance therapy has been shown to improve the quality of response and disease control and, in some studies, survival. Studies support maintenance therapy for high-risk patients as a standard of care, and there are emerging data supporting maintenance therapy in standard-risk patients to improve progression-free and possibly overall survival. Multidrug regimens combining a proteasome inhibitor and an IMiD have shown exceptional response outcomes with acceptable increases in toxicity in both the frontline and salvage settings, and are becoming a standard treatment approach. Moving forward, the use of immunophenotypic and molecular response criteria will be essential in better understanding the impact of highly active and continuous treatment regimens across myeloma patient populations. Future translational studies will help to develop antimyeloma agents to their fullest potential. The introduction of novel targeted therapies, including the IMiD pomalidomide and the proteasome inhibitors carfilzomib and ixazomib (MLN9708), will provide greater options to individualize treatment and help patients achieve a clinically meaningful response.
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影响因子：
168.9
作者：
Cavo, Michele;Tacchetti, Paola;Baccarani, Michele
通讯作者：
Baccarani, Michele
影响因子：
6.5
作者：
Davies, FE;Forsyth, PD;Morgan, GJ
通讯作者：
Morgan, GJ
影响因子：
45.3
作者：
Durie, BGM;Jacobson, J;Crowley, J
通讯作者：
Crowley, J
DOI：
10.1200/jco.2011.37.8919
发表时间：
2012-02-01
期刊：
Journal of clinical oncology : official journal of the American Society of Clinical Oncology
影响因子：
--
作者：
Anderson KC
通讯作者：
Anderson KC
影响因子：
11.4
作者：
Durie, B. G. M.;Harousseau, J-L;Rajkumar, S. V.
通讯作者：
Rajkumar, S. V.