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KOS 2007: Debate I - Should CR Achievement Be a Major Treatment Objective? No!
Mario Boccadoro, MD
Divisione di Ematologia dell’Università di Torino
Azienda Ospedaliera San Giovanni Battista
Torino, Italy

Includes questions and comments from the audience.
06.27.07

AUTHORS: M. Boccadoro, F. Cavallo, P. Falco, I. Avonto, A. Larocca, F. D'Agostino, A. Palumbo
From the Divisione di Ematologia dell’Università di Torino, Azienda Ospedaliera San Giovanni Battista, Torino, Italy








SUMMARY:
by Lynne Lederman, PhD

Dr. Boccadoro maintained that there was no direct relationship between CR and survival, using data from other trials, although he acknowledged that in any tumor, in any setting, increasing the CR rate is the first step toward a cure. He suggested three reasons that CR should not be a treatment objective, although he suggested changing his point from “no” to “yes, but.” First, CR might be a cosmetic effect of the therapy, and that EFS in his opinion is a better measure of disease stabilization. Second, in patients with high serum free light chain levels, a marker of an aggressive myeloma subtype with poor prognosis, rapid response to treatment might be defined as CR, but EFS and OS are poor. Third, CR may be associated with increased survival in patients whose disease was benign anyway; this may be clarified in the future using gene expression profiling.

Dr. Harousseau commented that studies from the 1990s where CR rates were very low, cannot be compared with more recent studies where CR rates are very high. Both he and Dr. Boccadoro commented that whether CR after novel therapies was equivalent to CR after chemotherapy or high dose therapy remained to be determined. Dr. Harousseau pointed out that OS depends in part on the efficacy of salvage therapy after relapse.

Dr. Alexanian pointed out in a review of trial data that CR was not necessarily a prerequisite for 10 year survival, but that patients with CR did have a better chance of surviving 15 to 20 years. There are several pathways to CR, and if CR lasts over two years, patients will tend to have a long survival.


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