By Paul Kleutghen | Posted - Jul 23rd, 2021

 

 

 

 

Use of Beta-Blockers Improves Outcomes for Myeloma Patients on Pomalyst

Many of us myeloma patients may be familiar with the class of drugs called “beta-blockers.” The website of the Mayo Clinic posts “Beta-blockers, also known as beta-adrenergic blocking agents, are medications that reduce your blood pressure. Beta-blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. Beta-blockers cause your heart to beat more slowly and with less force, which lowers blood pressure. Beta-blockers also help open up your veins and arteries to improve blood flow.

There are several different kinds of beta-blockers marketed under names such as Acebutolol (Sectral), Atenolol (Tenormin), Bisoprolol (Zebeta), Metoprolol(Lopressor, Toprol XL), Nadolol (Corgard), Nebivolol (Bystolic), and Propranolol (Inderal, InnoPran XL).

A recent letter to the editor of the European Journal of Haematology summarizes the results of a retrospective observational study done at the Mayo Clinic. The investigational team analyzed the outcomes of 208 myeloma patients that had been enrolled in a previous study that studied the outcomes of pomalidomide (Pomalyst) + dexamethasone. These patients were treated for relapsed/refractory disease.

As it turned out, 77 patients had documented use of beta-blockers for more than 3 months at any time following their multiple myeloma diagnosis. There were no statistical differences between the beta-blocker and non-beta-blocker groups with respect to the year of diagnosis, sex, number of prior line therapies and presence of high-risk features [deletion of 17p, t(14;16), t(14;20); t(4:14) or 1q gain].

The only ‘large’ difference between the two groups was age: median of 68 years for the beta-blocker group compared to a median of 61 years for the non-beta-blocker group.

The results of this analysis are interesting, to say the least:

  • Median progression free survival for the beta-blocker group was 10.9 months compared to 6.1 months for the others
  • The overall survival from diagnosis of the 77 patients taking beta-blockers (median of 107 months), was significantly longer than for the patients not taking beta-blockers (median of 86 months)
  • The response rates of the two groups of patients were also  different, though not statistically so (due to the small sample size)

 

Response Rate Beta- Blockers No Beta- Blockers
Very Good Partial Response or Better 28% 20%
Partial Response or Better 43% 34%

 

The analysis also concluded that not only beta-blocker intake, but also the duration of the beta-blocker usage were two independent prognostic factors for progression free survival.

In addition, beta-blocker usage was even more prognostic for progression free survival compared to both the presence of high-risk myeloma features and the number or prior line treatments.

Please note that these results, in the absence of other studies, are valid only for those patients on a regimen of pomalidomide + dexamethasone. Happily, most of the beta-blockers are cheap when compared to typical myeloma therapy. For example, atenolol and metoprolol can be purchased at Wal-Mart for $4 for a 30-day prescription (without insurance). Other large drug store chains have similar discounted drug programs. For us, four bucks for a prescription is a treat for a class of drugs that could potentially improve our outcomes.

We look forward to more study using this simple class of drugs. 

 

 

 
Paul Kleutghen
About the Author

Paul Kleutghen - I am a patient diagnosed in 2014 with primary plasma cell leukemia (pPCL), a rare and aggressive variant of multiple myeloma and have been very fortunate to find treatment at the division of Cellular Therapy at the Duke University Cancer Institute. My wife, Vicki, and I have two adult children and a grandson who is the ‘light of my life’. Successful treatment has allowed Vicki and I to do what we love best : traveling the world, albeit it with some extra precautions to keep infections away. My career in the pharmaceutical industry has given me insights that I am currently putting to use as an advocate to lower drug pricing, especially prices for anti-cancer drugs and, very specifically, CAR-T therapies, with recent contributions posted by Health affairs, the Institute for Clinical and Economic Review and the Centers for Medicare and Medicaid Services.

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