Lenalidomide Improves Quality of Life in Non-Del5q MDS

Treatment with lenalidomide (Revlimid) improved health-related quality of life (HRQoL) compared with placebo after 24 weeks for low to intermediate risk patients with non-deletion 5q myelodysplastic syndromes (MDS), according to a secondary endpoint analysis of the MDS-005 trial presented at the 2015 International MDS Symposium.

Results from MDS-005, originally presented at the 2014 ASH Annual Meeting, demonstrated that significantly more patients treated with lenalidomide achieved red blood cell transfusion independence (RBC-TI) of at least 56 days compared with placebo (26.9% [43/160 patients] vs 2.5% [2/79 patients]; P <.001), the primary endpoint of the multicenter randomized placebo-controlled study.

Based on the results of MDS-005, Celgene plans to submit a regulatory filing with the FDA in the second half of 2015.

In the current analysis, presented by Valeria Santini, MD, HRQoL was assessed as a secondary endpoint using the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire at baseline, every 12 weeks thereafter, and at discontinuation.

The questionnaire gathered data on fatigue, dyspnea, physical functioning, emotional functioning and global quality of life from 122 patients who received lenalidomide and 56 who received placebo. All patients included in the study had low or intermediate risk, transfusion dependent MDS that was non-del-5q, and were unresponsive or refractory to erythropoiesis-stimulating agents.

Patients underwent a baseline HRQoL assessment. At week 12, mean changes in HRQoL scores from baseline were not significantly different between treatment arms for the preselected domains. However, by week 24, HRQoL score changes favored lenalidomide versus placebo for all preselected domains. After adjusting for baseline scores, improvement was statistically significant for emotional functioning (P = .047) but not other domains.

“This analysis provides new insights into the clinical results of lenalidomide in non-del-5q patients,” said Santini. “We now have a better understanding of how achievement of transfusion independence impacts quality of life measures.”

RBC-TI of at least 8 weeks was associated with significant improvement (P <.01) across all preselected domains, with improvements also exceeding the prespecified threshold for clinically meaningful change.

In the study, the most common adverse events associated with lenalidomide were related to myelosuppression, including neutropenia (64.4% vs 11.4%) and thrombocytopenia (39.4% vs 7.6%). Grade 3/4 neutropenia occurred in 61.9% and 12.7% in the lenalidomide and placebo groups, respectively, and grade 3/4 thrombocytopenia occurred in 35.6% versus 3.8%.

The FDA granted lenalidomide Subpart H approval in 2005 for patients with transfusion-dependent anemia due to low or intermediate-1 risk MDS associated with a deletion 5q cytogenetic abnormality. The drug is currently only available under a special restricted distribution program. The Risk Evaluation and Mitigation Strategy (REMS) program is designed to avoid embryo-fetal exposure to lenalidomide, as the drug is linked to birth defects or death of unborn babies. Risk impacts both women and men, as lenalidomide can pass into human semen.

In 2006 lenalidomide was approved for use in combination with dexamethasone in patients with multiple myeloma who have received one prior therapy. In February 2015, the FDA expanded this multiple myeloma indication to include use in combination with dexamethasone in newly diagnosed patients. The drug also received approval for the treatment of mantle cell lymphoma in 2013 for use in patients whose disease has relapsed or progressed after two prior therapies, one of which included bortezomib (Velcade).

Santini V, Almeida A, Giagounidis A, et al. The effect of lenalidomide on health-related quality of life (HRQoL) in patients with MDS: results from the MDS-005 trial. Leukemia Research. 2015;39:1s (suppl; abstr 116).

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