In a nutshell
This study evaluated CyBorD (cyclophosphamide, bortezomib, dexamethasone) with or without a switch to another regimen mid-treatment for elderly patients with multiple myeloma (MM). The authors concluded that CyBorD was promising for these patients and that switching to VTD chemotherapy during treatment provided better long-term outcomes.
Initial treatment of MM often depends on whether a patient is a good candidate for a stem cell transplant. For patients who are not good candidates, VMP (bortezomib, melphalan, prednisolone) chemotherapy is one standard treatment option. However, this treatment is not usually recommended for elderly patients due to side effects.
Previous studies have suggested that CyBorD chemotherapy may be more effective for patients who cannot have a stem cell transplant. However, another regimen called VTD may be more effective. This regimen replaces cyclophosphamide (Cytoxan) with thalidomide (Thalomid). Whether this regimen is effective and safe for elderly patients with MM is unclear.
Methods & findings
This study included 155 elderly patients with newly diagnosed MM. These patients were not good candidates for a stem cell transplant. Patients were divided into two groups. One group received CyBorD alone for up to 9 cycles of treatment. The other group received at least 7 cycles of CyBorD and then switched to VTD. Patients were followed-up for an average of 31.9 months.
79.4% of all patients achieved at least a partial response (tumor shrinkage or no further growth) or better. 52.9% of these patients had a very good partial response. Overall, patients survived for an average of 45.1 months.
At follow-up, all patients survived for an average of 17.0 months without treatment-related complications, such as tumor growth. This interval was significantly shorter for patients over age 80 compared to younger patients (8.6 months vs. 17.7 months). However, patients who switched to VTD therapy survived for significantly longer without complications compared to patients who had CyBorD only (25.4 months vs. 20.3 months).
In total, 77 patients switched to VTD chemotherapy. These patients survived for significantly longer without treatment-related complications compared to the CyBorD group (25.4 months vs. 20.3 months).
In the 31.6% of patients did not finish all 9 cycles of CyBorD due to side effects. 23.5% of patients who received VTD switched back to CyBorD due to side effects.
The bottom line
This study concluded that CyBorD chemotherapy showed promise for elderly patients with MM who could not have a stem cell transplant. The authors suggest that consolidation treatment with thalidomide may further improve long-term outcomes for these patients.
The fine print
This study was retrospective, meaning it analyzed data going back in time. Also, only 20 patients switched over to the VTD regimen. This may limit the conclusions that can be drawn from these results.
If you are not eligible for a stem cell transplant, talk to your care team about the potential benefits of CyBorD or VTD chemotherapy.
Published By :
British Journal of Haematology
Jul 12, 2019
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