Should low-dose induction dexamethasone be standard of care in multiple myeloma?
In the ECOG trial, high-dose dexamethasone achieved higher response rates than low-dose dexamethasone, but this advantage failed to translate to better survival. Dr. Rajkumar said that response rates have often been unreliable in identifying regimens with the best overall survival. In fact, even complete response (CR) rates are sometimes unreliable. During the first four cycles, response rates—CR and partial response (PR)—were 82% in the high-dose arm vs 79% in the low-dose arm. CR/very good PR rates were 52% vs 42%, respectively. “The interactions between complete response and overall survival are similar to opinion polls done months before an election. They often predict the winner, but are not consistent,” he said. In his opinion, high-dose dexamethasone, which is more toxic than low-dose dexamethasone, should be the experimental arm of a clinical trial, not the standard arm. “I am more conservative. I want proof that high-dose dexamethasone leads to a better outcome in terms of sur
