Dr. Chari on the E3A06 Trial in Smoldering Myeloma

Ajai Chari, MD, associate professor, hematology and medical oncology, Mount Sinai Hospital, discusses the phase III E3A06 study, which looked at the effects of lenalidomide (Revlimid) in patients with smoldering myeloma.

At the 2019 ASCO Annual Meeting, the results of the phase III E3A06 study were presented where patients were randomized to either lenalidomide or observation. Results showed that there was a significant reduction in the risk of progression with lenalidomide. The 3-year progression-free survival rate was 91% for lenalidomide versus 66% with the observation arm, suggesting that lenalidomide is favorable, according to Chari.

However, there are some limitations in this study because it included all types of smoldering myeloma, including some low-risk and intermediate-risk patients. Those patient populations did not seem to benefit as much, according to Chari, because their natural disease subtypes have better outcomes.

Additionally, the field is still awaiting further details on the endpoints, and there were concerns about some toxicity with higher rates of secondary malignancy, Chari concluded. About 50% of patients in the lenalidomide treatment arm discontinued due to toxicity.