I have a 58M BMI 39, afib on eliquis, HTN, OSA on CPAP, and IgG lambda MM, R-ISS 1, standard risk cytogenetics, s/p RVDx6 in 2018, declined transplant and went on revlimid maintenance (15mg) since 2018. Labs show no evidence of MM, last BM 2021 showed no MM (MRD not assessed). He recently developed a Gleason 4+5 localized prostate cancer and is undergoing RT and ADT. Would you stop revlimid in the setting of another cancer, and how do you differentiate the possibility of whether his prostate cancer is related to revlimid vs sporadic? Additionally would you (a) continue revlimid, (b) stop revlimid (i.e. if he is MRD negative), or (c) change to an alternative maintenance regimen.
I do not stop lenalidomide (if I would otherwise continue it) for someone who develops a second tumor that is fairly common like prostate cancer. It is virtually impossible to prove that the prostate cancer is related (although it could be). I have treated about 4 concurrent prostate cancer + MM in the last few years, and used lenalidomide while patients are undergoing radiation. There is data to suggest safety of VRd concurrent with radiation etc. There is no high quality evidence to guide us in this situation. If you ask what my personal preference is- I think that if patient is tolerating len well without any other toxicity (including financial)-I would recommend you continue. Consider getting a flow MRD assay this year- if five years out, and MRD negative- I do think (and this is my opinion)- that stopping lenalidomide would not lead to adverse "overall" survival.
