Health-related quality of life is an important factor to consider when treating patients with multiple myeloma. Now, there are more treatment regimens and combinations than ever, and it is vital that healthcare teams understand how these drugs impact patients in their day-to-day, explained David S. Siegel, MD, PhD.
Siegel, the chief of the myeloma division at the John Theurer Cancer Center, was recently involved in a study that examined health-related quality of life for patients with relapsed or refractory myeloma who were taking the 3-drug regimen of pomalidomide (Pomalyst), low-dose dexamethasone, and daratumumab (Darzalex) after lenalidomide (Revlimid) treatment.
“It's nice to know that we're not only able to control the disease way better than we used to, but that we now have tools that don't slam the patient while we're doing that,” Siegel said in a recent interview with OncLive, a sister publication of Oncology Nursing News.
Oncology Nursing News: Can you provide insight into how health-related quality of life has become an important aspect of myeloma treatment?
Siegel: We spent many decades without any new drugs in multiple myeloma, so quality of life was unfortunately largely ignored because we were just desperately looking for drugs that had activity.
Now, all of a sudden, we have a multitude of drugs. Thankfully, many of them are very effective, so it becomes a question as to, 'What is the impact of these drugs on quality of life?' This [3-drug regimen] is a very important combination in myeloma right now, and this is the first attempt to look at quality of life related to the administration of daratumumab, pomalidomide, and dexamethasone.
Can you give a brief background on this research, as well as the findings?
Daratumumab and pomalidomide are 2 of the most important drugs that have come along in the last decade for the management of myeloma. The combination of daratumumab, pomalidomide, and dexamethasone is very important.
But one of the major issues in multiple myeloma is this impression that you have to change classes of drugs. So [lenalidomide] is the most widely used drug in myeloma. Pomalidomide is a very similar molecule to [lenalidomide], so there's a lot of concern over whether you can go from one to the other. The overarching finding of this trial is that you can do it both safely and with a significant degree of efficacy.
Now, we have a great regimen, we know where we can use it, but what impact does it have on quality of life? This is the first assessment of that, and it does it in a unique setting in that this is very early in the treatment of myeloma, so most of the patients are still very healthy. When you're very sick from the myeloma, just controlling the myeloma is enough to improve the quality of life fairly significantly. But these are patients who have not been dramatically compromised by the myeloma itself. So, you expect this 3-drug combination, particularly one including corticosteroids, to have a negative impact on patients' functionality and perception of quality of life. But that wasn’t the case.
We used a number of tools. There's a visual scoring from 1 to 100 (of) ‘How do you feel?’ The patients came in feeling fairly well, with scores of around 90, and they came out of the trial with scores of about 90. And then you have this 5-question panel of 'How are you interacting with your friends? How mobile are you? What impact does this have on you psychologically? How does it impact your daily activities?' The bottom line is it was basically stable across all those parameters. If there was a change, it was to have slight improvements. So, you have a 3-drug combination that is highly effective and didn't negatively impact on the patients' quality of life. In fact, they had improved quality of life, despite the fact that they came into this study, so it's interesting.