Treatment combinations for multiple myeloma patients with the 17p deletion

This study analyzed the results of 13 separate studies on treatment combinations for multiple myeloma patients with the 17p deletion. This study concluded that bortezomib-based primary and maintenance therapy improved outcomes in newly diagnosed patients with the 17p deletion. The combination of carfilzomib or elotuzumab with Rd can improve outcomes for relapsed/refractory patients with the 17p deletion.

Advances in first-line treatments have improved response and survival rates among multiple myeloma patients. Biologic therapies, such as lenalidomide (Revlimid), use the patient's immune system to fight cancer. Lenalidomide is often combined with the steroid dexamethasone (Decadron). This combination is commonly referred to as Rd. Other biologic therapies include bortezomib (Velcade), elotuzumab (Empliciti), carfilzomib (Kyprolis), ixazomib (Ninlaro), and pomalidomide (Pomalyst). These can be combined with Rd, with a chemotherapy, or used alone.

Certain chromosomal abnormalities (changes in the genetics of a cell) in multiple myeloma, such as deletion (17p), can make it more difficult to treat. Patients who have relapsed or those no longer responding to standard therapy (refractory disease) are also at high risk of progression. Which treatment regime is most suitable for high-risk patients is still under investigation. 

This study analyzed the results of 13 separate studies. The studies examined different treatment combinations for newly diagnosed as well as relapsed/refractory multiple myeloma. A total of 3,187 multiple myeloma patients were included. 685 patients had deletion (17p).

The overall response rate to a new biologic therapy was 67.1% in patients with relapsed/refractory multiple myeloma without the 17p deletion. Those with the 17p deletion and relapsed/refractory disease showed an overall response rate of 40.5%.

The combination of bortezomib with dexamethasone and the chemotherapy adriamycin was associated with good outcomes in newly diagnosed patients with deletion (17p) when it was followed by bortezomib maintenance therapy. The average time to progression was 25.7 months and overall survival (OS; time from treatment until death from any cause) at 36 months was 62%. This was significantly greater compared to patients not receiving adriamycin or those treated with vincristine instead of bortezomib (average time to progression was 12 to 14.6 months and OS was 8%).

The longest time to progression in patients with the 17p deletion and relapsed/refractory disease was observed with carfilzomib plus Rd (24.5 months). This was followed by elotuzumab plus Rd (21.2 months) and ixazomib plus Rd (15.7 months). Rd with or without bortezomib was associated with a progression-free survival of 2 to 14.9 months. It was 4.6 to 7.3 months for pomalidomide plus dexamethasone and 1.1 months for those treated with dexamethasone alone.

Average OS among patients with the 17p deletion and relapsed/refractory disease was over 42.3 months with elotuzumab plus Rd. Rd with or without bortezomib was associated with an overall survival of 4.7 to 36.4 months. It was 12 to 12.6 months for pomalidomide plus dexamethasone, 7.7 months for those treated with dexamethasone alone, and 7 months for carfilzomib alone.

Progression-free survival in patients with relapsed/refractory multiple myeloma without the 17p deletion ranged from 2.3 months (dexamethasone alone) to 18.5 months (elotuzumab plus Rd). OS ranged from 9 months (dexamethasone alone) to 42.3 months (elotuzumab plus Rd).

This study concluded that bortezomib-based primary and maintenance therapy improved outcomes in newly diagnosed patients with the 17p deletion. The combination of carfilzomib or elotuzumab with Rd can improve outcomes for relapsed/refractory patients with the 17p deletion.