Clarithromycin with low dose dexamethasone and thalidomide is effective therapy in relapsed/refractory myeloma

Abstract

SummaryA combination of clarithromycin, low dose of thalidomide and low dose dexamethasone was used in a phase II study to treat patients with relapsed and refractory myeloma. Thirty patients received clarithromycin 250 mg twice daily and thalidomide 50 mg at night on an ongoing basis with 4-d pulses of 10 mg dexamethasone given monthly. Eight patients had permitted escalation of thalidomide dosage up to 200 mg daily. The combination was well tolerated and could be given to elderly, infirm and severely cytopenic patients. Response rates were high, with 89% achieving at least 50% reduction in paraprotein and a 96% overall response rate. Although clarithromycin has only minimal anti-myeloma properties when used as a single agent, its combination with thalidomide and dexamethasone appears very effective, allowing these to be used in lower and more tolerable doses with good clinical effects.

Clarithromycin (Biaxin)‐lenalidomide‐low‐dose dexamethasone (BiRd) versus lenalidomide‐low‐dose dexamethasone (Rd) for newly diagnosed myeloma

“…The putative efficacy was buttressed by a recent report where the same combination of drugs was used: however the dexamethasone was used in high-dose. Results were almost comparable with BLT-D (16). …”

Plasma cell leukemia: a highly aggressive monoclonal gammopathy with a very poor prognosis

“…Based on observation that in PCL the response to standard therapy is extremely poor and the use of thalidomide in advanced MM has resulted in marked responses even in patients with advanced diseases, including those who relapsed after high-dose chemotherapy [69][70][71][72], some authors have used this promising drug also in patients with PCL [73,74]. Wohrer et al [75] reported the use of thalidomide in a patient with PPCL as a first line therapy achieving a very good partial response rapidly.…”

Repurposing Drugs in Oncology (ReDO)—clarithromycin as an anti-cancer agent

“…According to Niesvizky et al the addition of CAM would allow a lower dose of dexamethasone while maintaining a high response rate. Indeed, Morris et al reported an overall response rate of 96%, of which 89% had at least 50% reduction in paraprotein, in relapsed and refractory myeloma patients when they received CAM combined with low dose dexamethasone and low dose thalidomide [38]. …”

“…Such combinations have been used in more than ten different trials [33–35, 37, 38, 40, 41, 44, 47, 91–93]. As such, CAM augments the response to dexamethasone when given alone or in combination with thalidomide to patients with MM [37, 94].…”