Key data presented from the Spanish Myeloma Group
Recent advances in treatment of mutiple myeloma, including the introduction of the immune modulators, thalidomide and lenalidomide and the proteasome inhibitor bortezomib have improved patient outcomes. With several treatment options from which to choose, and with even more possibilities for combining and sequencing them with each other, and with conventional agents, many important questions surround the optimal treatment of multiple myeloma.
At the ASH 2009 congress Dr. Maria-Victoria Mateos from the Hospital Universitario de Salamanca in Spain presented results on behalf of the Spanish Myeloma Group from a prospective, randomised trial in older patients with newly diagnosed multiple myeloma. This study compared induction treatment with bortezomib, melphalan, and prednisone (VMP) to bortezomib, thalidomide (100 mg/day), and prednisone (VTP). This was followed by maintenance treatment with either bortezomib and thalidomide (VT) or bortezomib and prednisone (VP).
A total of 260 patients were enrolled. Individuals who completed six cycles of induction were then randomised to maintenance with VT or VP for up to three years. The doses and schedules employed for maintenance included bortezomib 1.3 mg/m2 administered on days 1, 4, 8, and 11 every three months, in combination with either continuous thalidomide 50 mg daily (VT) or prednisone 50 mg every other day (VP).
One of the key findings was that the group treated with VMP induction followed by VT maintenance had statistically significant better progression-free survival than those treated with VTP followed by VP. Similar responses were noted in standard and high-risk groups, indicating that both of these therapeutic regimens can overcome traditional indicators of poor prognosis.
With respect to adverse events, VMP induction therapy was associated with a higher incidence of neutropenia and a higher incidence of infections than VTP. In contrast, VTP therapy was associated with a higher incidence of peripheral neuropathy than VMP as well as a higher incidence of serious cardiac events, although the absolute number of such events was small.
Most important, in Dr Mateos' view, was the observation that these induction and maintenance regimens showed the ability to "overcome the poor prognosis of high-risk elderly multiple myeloma patients."
Source: ASH 2009
Watch an interview with Dr. Maria-Victoria Mateos on ecancertv here