In a nutshell
This study compared different treatment combinations for previously untreated multiple myeloma, including bortezomib (Velcade), dexamethasone (Ozurdex), cyclophosphamide (Cytoxan), and lenalidomide (Revlimid). This study concluded that a combination of all four therapies did not improve response rates beyond combinations of three therapies. Three-agent combinations were highly effective.
Some background
New treatments developed in recent years have changed the initial therapy options for multiple myeloma. Bortezomib is a proteasome inhibitor. The proteasome is involved in cancer cell growth and death. Blocking the proteasome can decrease cell growth and increase cell death. Lenalidomide is a treatment that stimulates the immune system against myeloma cells. These treatments have been shown to improve response rates, and are now often used in combination with other agents.
Dexamethasone is a corticosteroid used to treat inflammation. Cyclophosphamide is a chemotherapy agent. These treatments have been effective when combined with bortezomib or lenalidomide. It is not clear whether a combination of all four treatments would be even more effective.
Methods & findings
The current study compared the four treatment combination to two different three-treatment combinations. 140 patients were randomly assigned to one of four groups. The VDCR group was treated with bortezomib, dexamethasone, lenalidomide, and cyclophosphamide. The VDR group did not receive cyclophosphamide. The VDC group did not receive lenalidomide. The VDC-mod group were treated with an extra dose of cyclophosphamide compared to the VDC group. All patients were treated with bortezomib maintenance (long-term) therapy to prevent relapse. Patients were followed for an average of 15–22 months.
A very good partial response (decrease in cancer activity) was noted in 41%–58% of patients, depending on the group. A complete response was seen in 25% of the VDCR group, 24% of the VDR group, 22% of the VDC group, and 47% of the VDC-mod group. One-year progression free survival (time from treatment until disease progression) ranged from 83% in the VDR group to 100% in the VDC-mod group.
Common negative side effects included blood toxicity, nerve pain in the arms and legs, fatigue, and gastrointestinal issues.
The bottom line
This study concluded that a combination of four treatments did show a significant improvement over the very effective three treatment combinations.
Published By :
Blood
Date :
May 10, 2012
