Evaluating results from the multiple myeloma patient subset treated with denosumab or zoledronic acid in a randomized phase 3 trial

N. Raje, S. Vadhan-Raj, W. Willenbacher, E. Terpos, V. Hungria, A. Spencer, Y. Alexeeva, T. Facon, A. K. Stewart, A. Feng, A. Braun, A. Balakumaran, G. David Roodman

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Abstract

In a phase 3 trial of denosumab vs zoledronic acid in patients (n=1776) with bone metastases and solid tumors or multiple myeloma, denosumab was superior to zoledronic acid for the primary end point of prevention of skeletal-related events. There was no difference in overall survival between the two groups; however, an ad hoc overall survival analysis in the multiple myeloma subset of patients (n=180) favored zoledronic acid (hazard ratio (HR) 2.26; 95% confidence interval (CI) 1.13-4.50; P = 0.014). In the present analysis, we found imbalances between the groups with respect to baseline risk characteristics. HRs with two-sided 95% CIs were estimated using the Cox model. After adjustment in a covariate analysis, the CI crossed unity (HR 1.86; 95% CI 0.90-3.84; P = 0.0954). Furthermore, we found a higher rate of early withdrawals for the reasons of lost to follow-up and withdrawal of consent in the zoledronic acid group; after accounting for these, the HR was 1.31 (95% CI 0.80-2.15; P = 0.278). In conclusion, the survival results in multiple myeloma patients in this trial were confounded and will eventually be resolved by an ongoing phase 3 trial.

Original languageEnglish (US)
Article numbere378
JournalBlood Cancer Journal
Volume6
DOIs
StatePublished - Jan 8 2016

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ASJC Scopus subject areas

  • Oncology
  • Hematology

Cite this

Raje, N., Vadhan-Raj, S., Willenbacher, W., Terpos, E., Hungria, V., Spencer, A., Alexeeva, Y., Facon, T., Stewart, A. K., Feng, A., Braun, A., Balakumaran, A., & Roodman, G. D. (2016). Evaluating results from the multiple myeloma patient subset treated with denosumab or zoledronic acid in a randomized phase 3 trial. Blood Cancer Journal, 6, [e378]. https://doi.org/10.1038/bcj.2015.96