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In the treatment of multiple myeloma, the addition of Velcade® (bortezomib) to Alkeran® (melphalan) and prednisone significantly improves progression-free and overall survival compared with Alkeran/prednisone only. These results were recently published in the New England Journal of Medicine.

Multiple myeloma is diagnosed in approximately 20,000 people annually in the United States. It is the second most common hematologic malignancy (cancer originating in blood cells). Multiple myeloma is a cancer of the blood that affects the plasma cells. Plasma cells are an important part of the immune system; they produce antibodies to help fight infection and disease. Multiple myeloma is characterized by an excess production of abnormal plasma cells. Symptoms include increased risk of bacterial infections and impaired immune responses. Because patients whose cancer has returned following prior therapy are typically considered incurable, the goal of treatment is to extend survival and maintain quality of life.

Velcade is considered a proteosome inhibitor. Proteosomes are proteins found in virtually all cells. They are responsible for the breakdown and reuse of a cell’s other proteins. Proteosomes regulate several aspects of cellular activity, including survival. By inhibiting proteosomes, Velcade has demonstrated an ability to reduce cellular survival.

Standard initial therapy for patients with multiple myeloma who are not eligible for a stem cell transplant is the chemotherapy agent Alkeran plus the steroid prednisone. Researchers affiliated with the VISTA trial recently conducted a trial to evaluate the effectiveness of the addition of Velcade to standard therapy among patients with multiple myeloma who were not eligible for a stem cell transplant. This trial included 682 patients who were treated with either Velcade in combination with Alkeran and prednisone or Alkeran and predisone only (control group).

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  • Time to cancer progression was 24 months for those who received Velcade compared with 16.6 months for those in the control group.
  • Regression of cancer was achieved in 71% of patients treated with Velcade compared with 35% in the control group.
  • Only 35% of patients treated with Velcade received subsequent therapy within two years compared with 57% of those in the control group.
  • After a median of 16.3 months follow-up, death occurred in 13% of patients treated with Velcade compared with 22% of patients in the control group.
  • Median survival has not been reached by either group of patients.
  • Serious side effects occurred in 46% of patients treated with Velcade, compared with 36% in the control group.

The researchers concluded that these “findings suggest that bortezomib plus melphalan–prednisone is a valuable front-line treatment for patients with myeloma who are 65 years of age or older and cannot receive more aggressive treatment.” The authors also stated, “Bortezomib plus melphalan–prednisone was superior to melphalan–prednisone alone in patients with newly diagnosed myeloma who were ineligible for high-dose therapy.”

Patients diagnosed with multiple myeloma who are not eligible for a stem cell transplant may wish to speak with their physician regarding their individual risks and benefits of treatment including Velcade.

Reference: San Miguel J, Schlag R, Khuageva N, et al. Bortezomib plus melphalan and prednisone for initial treatment of multiple myeloma. New EnglandJournal of Medicine. 2008;359:906-917.