NEJM Audio Summary - May 10, 2012

Excerpted Script

0:41| "Continuous Lenalidomide Treatment for Newly Diagnosed Multiple Myeloma" by Antonio Palumbo, from the University of Turin, Italy.
Lenalidomide has tumoricidal and immunomodulatory activity against multiple myeloma. This study compared melphalan–prednisone–lenalidomide induction followed by lenalidomide maintenance (MPR-R) with melphalan–prednisone–lenalidomide (MPR) or melphalan–prednisone (MP) followed by placebo in patients 65 years of age or older with newly diagnosed multiple myeloma.  The median progression-free survival was significantly longer with MPR-R (31 months) than with MPR (14 months) or MP (13 months). Response rates were superior with MPR-R and MPR (77% and 68%, respectively, vs. 50% with MP). After induction therapy, a landmark analysis showed a 66% reduction in the rate of progression with MPR-R  that was age-independent. MPR-R significantly prolonged progression-free survival in patients with newly diagnosed multiple myeloma who were ineligible for transplantation, with the greatest benefit observed in patients 65 to 75 years of age. 

多発性骨髄腫、クリニックで診療していると、ともすると鑑別診断からこぼれ落ちそうになる疾患だ。その治療に関し、サリドマイド誘導体の「レナリドミド」の有効性が話題になっている。日本でも薬価収載され、１日25㎎、１ヶ月に21日間服用し7日間休薬するスケジュールの場合、１ヶ月のレナリドミドの費用は、8,861円×５カプセル×21日 ＝ 930,405円で、１割負担で 93,040円となります。治療したくとも放置せざるを得ない患者さんの存在が懸念されます。