Phase 3 trial of three thalidomide-containing regimens in patients with newly diagnosed multiple myeloma not transplant-eligible

Impact of the affordability of novel agents in patients with multiple myeloma: Real‐world data of current clinical practice in Mexico

“…In addition, fluorescence in situ hybridization was not performed routinely in the current study patients because it is expensive and requires qualified centers, which are lacking in Mexico. 13,14 To the best of our knowledge, the first report on the activity of CTD as first-line therapy was a retrospective study in the United Kingdom in which it was considered to have higher efficacy and a faster response than polychemotherapy (cyclophosphamide, vincristine, dexamethasone, and melphalan) in patients destined for autoSCT. After controlling for disease stage and renal impairment, we still observed differences in survival; patients in the PubC cohort were found to have twice the risk of death as those in the PrivC group, suggesting that differences in treatment could have contributed to the worsened survival rates of patients in the PubC cohort.…”

“…This triple-drug regimen has been used when there is no access to newer antimyeloma drugs other than thalidomide. 13,14 To the best of our knowledge, the first report on the activity of CTD as first-line therapy was a retrospective study in the United Kingdom in which it was considered to have higher efficacy and a faster response than polychemotherapy (cyclophosphamide, vincristine, dexamethasone, and melphalan) in patients destined for autoSCT. 18 The same group reported a better response rate with attenuated CTD in patients determined to be unsuitable for autoSCT compared with melphalan and prednisone.…”

“…[5][6][7][8] Novel agents in the treatment of MM, such as proteasome inhibitors and immunomodulatory drugs, have been incorporated with autologous stem cell transplantation (autoSCT) as initial therapy to improve response rates and survival over the past 20 years. 13 Similarly, access to high-dose chemotherapy followed by autoSCT, a well-recognized standard of care among eligible patients since the 1990s, is restricted in those areas of the world with limited resources. [10][11][12] Success in using bortezomib and lenalidomide as first-line therapy, as recommended by international guidelines, has been achieved at a high financial cost.…”

“…The majority of patients in these countries receive treatment regimens containing thalidomide as the only affordable "new" agent. 13 Similarly, access to high-dose chemotherapy followed by autoSCT, a well-recognized standard of care among eligible patients since the 1990s, is restricted in those areas of the world with limited resources. 14 Patients in Mexico receive health care from a system composed of the following 3 subsystems: 1) social security institutions that provide health services and nearly all medications for the formally employed and their families (approximately 60% of the population); 2) governmentfunded services headed by the Ministry of Health for the uninsured population, in which patients must pay at least part of the cost for services and medications due to a limited treatment package for certain high-cost diseases, excluding MM (30% of the population); and 3) a private sector financed out of pocket as well as the private insurance market, covering <10% of the population.…”

Navigating the treatment landscape in multiple myeloma: which combinations to use and when?

“…For example, regimens consisting of two or three drugs at full dose may be appropriate for patients defined as fit, while those defined as intermediate-fit may be treated with two (or three) drugs at a reduced dose, and those defined as frail with one or two drugs at a significantly reduced dose [17, 57]. In particular, CTD, MPT, CRD, Rd, VRd, or VMP may be suitable for fit or intermediate-fit patients [61, 69–71], while MP or cyclophosphamide and dexamethasone (CD) may be more appropriate for intermediate-fit or frail patients.…”