Bortezomib-Based Regimen Succeeds as Part of Frontline Therapy in Younger Patients With Multiple Myeloma

A phase 2 trial reported 100% 3-year overall survival rates with frontline therapy consisting of lenalidomide, bortezomib, and dexamethasone in younger patients with multiple myeloma.

According to the results of a phase 2 study published in the Journal of Clinical Oncology, lenalidomide, bortezomib, and dexamethasone constitute an effective combination for initial therapy of patients with multiple myeloma. The treatment course involves 2 cycles of initial therapy with the 3-drug combination, followed by hematopoietic stem cell transplant, and maintenance therapy with 1 year of lenolidomide.^1,2

This strategy, according to lead author Murielle Roussel, MD, "is feasible, with favorable tolerability and no treatment-related mortality."^1,2

Results of the phase 2 trial were favorable. In 31 patients with a median age of 58 years, and an age range of 33 to 65 years, the treatment course led to 100% overall survival at the 3-year mark and progression-free survival of 77% at the same time point. A complete response occurred in more than half (58%) of patients, and the end point of minimal residual disease activity was detected in more than two-thirds (68%) of patients.^1,2

Grade 1 or 2 sensory neuropathy was common, occurring in 55% of patients. Neutropenia of grade 3 or 4 severity occurred in more than one-third (35%) of patients. A total of 13% of patients experienced thrombocytopenia. Although 1 case of breast cancer and 1 case of basal cell carcinoma was reported in the trial, no treatment-related deaths occurred during the study.^1,2

According to investigators, the results of this trial may be further improved by administration of bortezomib subcutaneously, as the subcutaneous route of administration has been associated with lower rates of peripheral neuropathy than the intravenous route.³

References:

• Healio.com. Combination regimen safe, effective in treatment-naive myeloma. http://www.healio.com/hematology-oncology/hematologic-malignancies/news/online/%7B9f96a5aa-a84e-4913-9fb8-7f727dd86f16%7D/combination-regimen-safe-effective-in-treatment-naive-myeloma. Accessed August 2014.
• Roussel M, Lauwers-Cances V, Robillard N, et al. Front-Line transplantation program qith lenalidomide, bortezomib, and dexamethasone combination as induction and consolidation followed by lenalidomide maintenance in patients with multiple myeloma: a phase II study by the Intergroupe Francophone du Myélome [published online August 8, 2014]. J Clin Oncol. 2014.
• Moreau P, Pylypenko H, Grosicki S, et al. Subcutaneous versus intravenous administration of bortezomib in patients with relapsed multiple myeloma: a randomised, phase 3, non-inferiority study. Lancet Oncol. 2011;12(5):431-440.