Less intensive drug schedule as effective as standard treatment for blood cancer

August 23, 2010

A less intensive bortezomib-based regimen (given once instead of twice per week) followed by maintenance therapy, is as effective as the standard treatment for elderly patients with multiple myeloma, but with fewer serious side effects, and will be a valuable treatment option in these patients, according to an Article published Online First in The Lancet Oncology.

For more than 30 years, melphalan plus prednisone has been the mainstay of treatment for elderly patients with multiple myeloma. However, the addition of new agents such as thalidomide, bortezomib, and have improved response rates and extended life expectancies, but often with increased adverse effects. In 2008, the VISTA trial showed that the combination of bortezomib, melphalan, and prednisone was significantly better than the standard treatment of melphalan and prednisone alone, but toxic effects were high.

In this study, a team of researchers from Spain led by Maria-Victoria Mateos from the University Hospital of Salamanca investigated whether a less intensive bortezomib-based regimen of induction therapy supplemented with maintenance treatments could reduce toxic effects while maintaining efficacy.

The researchers designed a two-stage randomised trial to establish whether an alkylating agent (melphalan) or an immunomodulatory drug (thalidomide) would work better with bortezomib. 260 patients aged 65 years or older with untreated myeloma were randomly assigned to initial treatment with six cycles of reduced dosage bortezomib plus melphalan and prednisone (VMP; 130), or reduced dosage bortezomib plus thalidomide and prednisone (VTP; 130). Patients who completed induction therapy were subsequently randomly assigned to with bortezomib and prednisone (VP; 87) or bortezomib and (VT; 91) for up to three years.

Findings showed that the less intensive VMP and VTP induction regimens were effective and well tolerated with similar response rates —81% patients in the VTP group and 80% in the VMP group, including 36 (28%) VTP patients and 26 (20%) VMP patients had complete remission.

Treatment with VTP resulted in more serious adverse events (40 vs 20) and discontinuations (22 vs 15) than with VMP. Of the most common side effects (grade 3 or worse), infections (1% vs 7%) were more frequent with VMP while cardiac events (8% vs 0) and peripheral neuropathy (nerve pain [9% vs 7%]) were more common in the VTP group.

Importantly, this less intensive schedule was associated with a reduction in the incidence of grade 3 or higher peripheral neuropathy from 13% (in the previous VISTA trial) to 8%, and in gastrointestinal symptoms from 19% to 4%, while maintaining efficacy.

Additionally, maintenance therapy resulted in a substantial improvement in patient responses with good tolerability, increasing complete response from 23% to 42%, with no significant differences in response rates between the two regimens.

The authors conclude: "The therapeutic approach of reduced-intensity induction, followed by maintenance, with bortezomib-based therapy…is a safe and effective treatment for elderly patients with multiple myeloma."

In a Comment, S Vincent Rajkumar from the Mayo Clinic, Rochester, USA, says that this is an important study that immediately affects clinical practice by providing a safer dosing for . However, he points out that there are now five regimens for treatment of elderly patients with newly diagnosed shown to be effective in randomised trials, but no data on how these regimens compare: "We are faced with the challenge of selecting from treatments with significantly different side-effect profiles and route of administration without the benefit of randomised trials."

More information: www.thelancet.com/journals/lan … (10)70187-X/abstract

Related Stories

Recommended for you

Researchers unravel novel mechanism by which tumors grow resistant to radiotherapy

November 23, 2017
A Ludwig Cancer Research study has uncovered a key mechanism by which tumors develop resistance to radiation therapy and shown how such resistance might be overcome with drugs that are currently under development. The discovery ...

African Americans face highest risk for multiple myeloma yet underrepresented in research

November 23, 2017
Though African-American men are three times more likely to be diagnosed with multiple myeloma, a type of blood cancer, most scientific research on the disease has been based on people of European descent, according to a study ...

Encouraging oxygen's assault on iron may offer new way to kill lung cancer cells

November 22, 2017
Blocking the action of a key protein frees oxygen to damage iron-dependent proteins in lung and breast cancer cells, slowing their growth and making them easier to kill. This is the implication of a study led by researchers ...

One-size treatment for blood cancer probably doesn't fit all, researchers say

November 22, 2017
Though African-American men are three times more likely to be diagnosed with a blood cancer called multiple myeloma, most scientific research on the disease has been based on people of European descent, according to a study ...

One in four U.S. seniors with cancer has had it before

November 22, 2017
(HealthDay)—For a quarter of American seniors, a cancer diagnosis signals the return of an old foe, new research shows.

Combination immunotherapy targets cancer resistance

November 22, 2017
Cancer immunotherapy drugs have had notable but limited success because in many cases, tumors develop resistance to treatment. But researchers at Yale and Stanford have identified an experimental antibody that overcomes this ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.