Addition of lenalidomide to melphalan in the treatment of newly diagnosed multiple myeloma: the National Cancer Institute of Canada Clinical Trials Group MY.11 trial

Oral melphalan and prednisone remain an effective and tolerable treatment for patients with multiple myeloma. For approximately 40 years, this combination has been the standard of care for patients not proceeding to stem cell transplant. Within the last 10 years, new agents have been found to be efficacious in the relapsed/refractory setting. Within the last year, two trials of added thalidomide in the newly diagnosed setting have demonstrated outcomes superior to those achieved with melphalan and prednisone alone. This improved outcome comes at the cost of increased toxicity. The National Cancer Institute of Canada Clinical Trials Group (ncic ctg) has recently developed a randomized phase ii trial (MY.11) that uses a combination of lenalidomide with melphalan for patients with newly diagnosed multiple myeloma. Lenalidomide is a thalidomide analogue and, like thalidomide, is thought to work through immunomodulatory effects. It was shown to have activity in patients with relapsed or refractory disease and, in combination with dexamethasone, is superior to dexamethasone alone. Lenalidomide holds promise as a more effective and potentially less toxic derivative of thalidomide. Experience with lenalidomide in combination with chemotherapy is very limited, and the purpose of MY.11 is to establish tolerability and to gain knowledge about efficacy. The information gained from MY.11 is expected to help inform dosing levels and schedules for a large phase iii trial being developed by the Eastern Cooperative Oncology Group that will include participation by the ncic ctg.