Reducing infection-related morbidity and mortality in patients with myeloma
Mené au Royaume-Uni sur 977 patients atteints d'un myélome récemment diagnostiqué, cet essai de phase III évalue l'efficacité d'un traitement par lévofloxacine pour prévenir les infections et réduire les épisodes de neutropénie fébrile pendant les 12 premiers mois du traitement anticancéreux (durée médiane de suivi : 12 mois)
Myeloma survival has substantially improved in the past 10 years.Although most myeloma deaths are accountable to progressive disease, a substantial proportion of early deaths and deaths in remission are due to infections.Febrile infections induce considerable morbidity and frequently lead to drug interruption or drug discontinuation. Drug discontinuation can lead to inferior treatment responses, translating to poorer survival outcomes.
Agents with new mechanisms of action and drug combinations dominate current clinical investigations in myeloma. We commend researchers for drawing our focus to an area of supportive care in myeloma. Myeloma is a disease of the elderly, with 40% of newly diagnosed patients in the UK older than 75 years. In their Article in The Lancet Oncology, Mark Drayson and colleagues present findings that showed that 12 weeks of fixed-duration levofloxacin prophylaxis reduced the occurrence of febrile episodes and deaths (95 [19%] febrile episodes or deaths in 489 patients in the levofloxacin group vs 134 [27%] in 488 patients in the placebo group; hazard ratio [HR] 0·66, 95% CI 0·51–0·86; p=0·0018). Independent to levofloxacin, use of prophylactic low dose co-trimoxazole significantly reduced febrile infections and death. Additionally, use of levofloxacin for a fixed duration was not associated with an increase in adverse events; 597 serious adverse events were reported up to 16 weeks from the start of trial treatment—308 (52%) of which were in the levofloxacin group versus 289 (48%) in the placebo group).
The Lancet Oncology , commentaire, 2018