Less-intensive Treatment Regimen Effective against Multiple Myeloma

Less-intensive Treatment Regimen Effective against Multiple Myeloma

Adapted from the NCI Cancer Bulletin.

Treating patients who have multiple myeloma with less-intensive dosing of bortezomib (Velcade®) reduced toxic side effects without making the treatment less effective, Spanish researchers found. Their study, reported online in Lancet Oncology on August 23, 2010, concluded that less-intensive induction therapy with a bortezomib-based regimen, followed by maintenance treatments, was “a safe and effective treatment for elderly patients newly diagnosed with multiple myeloma.”

While bortezomib benefits many patients with multiple myeloma, some who take the drug have experienced severe nerve pain, known as peripheral neuropathy. To test less-intensive dosing, the researchers randomly assigned 260 patients to induction therapy of lower-intensity bortezomib plus melphalan and prednisone (VMP) or lower-intensity bortezomib plus thalidomide and prednisone (VTP), followed by one of two types of maintenance therapy for up to 3 years. With both induction regimens, bortezomib was given once a week after the first cycle rather than in the typical twice-weekly schedule.

Both of the less-intensive regimens led to response rates of more than 80 percent. In addition, 36 patients in the VTP group (28 percent) and 26 in the VMP group (20 percent) had complete remission. The regimens were associated with fewer cases of severe (grade 3 or higher) peripheral neuropathy and gastrointestinal symptoms than had been seen in a similar study known as the VISTA trial, in which more intensive-dosing of bortezomib was used.

“This is an important study that immediately affects clinical practice and provides important answers about how new agents such as bortezomib can be incorporated effectively in the overall treatment strategy,” wrote Vincent Rajkumar, M.D., of the Mayo Clinic in an accompanying editorial. “Although the trial was undertaken in newly diagnosed patients, the findings might also be of value in relapsed and refractory disease,” he added.

The regimen “could be a platform for further refinement of an optimized treatment for elderly patients with multiple myeloma through use of lenalidomide instead of thalidomide and by reducing adverse effects through early intervention and prophylactic measures,” Maria-Victoria Mateos, M.D., of the University Hospital of Salamanca and her colleagues concluded.