Frequently Asked Questions
February 13, 2011: Second Primary Cancers (SPCs)
Second primary cancers in myeloma have recently been in the news.
- What are second primary cancers (SPCs)?
These are additional cancers that occur in patients who already have myeloma.
- Is this something new?
No, this is something that has been recognized and studied since the 1970s.
- How often does it happen?
It happens in about 5 – 10% of patients.
- What causes these SPCs?
- Myeloma patients are predominantly over the age of 50 years and have a known risk of developing some type of additional cancer.
- Solid cancers such as breast and prostate cancer occur in myeloma patients at about the expected rate for the general population.
- Blood cancers such as leukemia, lymphoma, and MDS (myelodysplastic syndrome) occur more frequently than expected. This has been linked both to an underlying tendency to develop blood cancers as well as to DNA-damaging effects of certain treatments such as melphalan, radiation, and VP-16 (etoposide; sometimes used as part of the regimens for harvesting and consolidation).
- So what is the new question that has been in the news?
The specific new question right now is whether or not combining lenalidomide with conventional-dose melphalan and/or giving lenalidomide for an extended period after high-dose melphalan as part of autologous stem cell transplant increases the risk of developing SPCs.
- What led to this question?
At ASH in December, 2010, three randomized trials involving the comparison of lenalidomide (Revlimid®) versus placebo (no treatment) noted both longer remissions (42 versus 21 months approximately) and the occurrence of a small number of SPCs (up to 5.5%) in the patients who were treated with lenalidomide rather than placebo. This raised important questions and led to further review.
- What do the 145 members of the IMWG (International Myeloma Working Group) think about these results?
- A subgroup met to discuss the findings, and this was followed by a massive on-line debate over this past week.
- Although there was a strong desire to make recommendations, it was decided that more information is required first.
- When will more information be available?
- It is expected that more data will be presented publicly at both the IMW (International Myeloma Workshop) that will be held in May in Paris, and at ASCO in June.
- The full IMWG will meet in person at the International Myeloma Workshop in May and will make recommendations which will be available on the IMF website.
- The on-line global debate will continue among the IMWG members.
- What should patients do in the meantime?
- It is very important that secondary primary cancers be discussed with your personal physician.
- The main question is about the potential survival benefit with extended use of lenalidomide in the post-transplant setting versus the potential risk of developing SPCs over time.
- SPCs have not been associated with lenalidomide use in either the frontline setting or in relapsed/refractory cases. Contact the IMF if you have questions or concerns. The IMF will be posting updates on our website on a regular basis.
- What else is the IMWG doing regarding this issue?
The IMWG has established a Task Force to study patients who develop second cancers and will carefully review specific cancers if they occur. In addition, molecular and other biologic testing will be performed. Full details of this project will be released shortly on the IMF website.