According to results presented at the 2003 annual meeting of the American Society of Hematology (ASH), the treatment combination consisting of Doxil®, Oncovin® (vincristine), dexamethasone and Thalomid® (thalidomide) produces high anti-cancer response rates in patients with multiple myeloma. However, long-term follow-up and direct comparative clinical trials to different treatment approaches are necessary to determine the true clinical relevance of DVd-T in the treatment of multiple myeloma.
Multiple myeloma is a cancer involving important immune (infection-fighting) cells called plasma cells. Plasma cells aid the body in fighting infection by producing specialized proteins called antibodies that have the ability to target and/or kill foreign cells. In multiple myeloma, cancerous plasma cells produce abnormal and excessive antibodies that do not have the ability to properly fight infection. In addition, the cancerous plasma cells accumulate in the bone marrow, suppressing the normal formation and function of other cells that are necessary for normal production of blood cells and immune functions. The excessive accumulation of cancer cells in the bone marrow ultimately leads to the formation of tumors in the bone and to the breakdown of bone. Standard treatment for multiple myeloma is chemotherapy with or without stem cell transplantation.
Researchers from the Cleveland Clinic Myeloma Program recently conducted a clinical trial to evaluate a treatment combination including the chemotherapy agents Doxil® and Oncovin®, the steroid dexamethasone, and the anti-angiogenesis agent Thalomid® (DVd-T) in the treatment of patients with multiple myeloma. This trial consisted of 50 patients diagnosed with multiple myeloma who had received no previous therapy, and 50 patients with recurrent multiple myeloma. A complete disappearance of detectable cancer (complete remission) was achieved in 46% of newly diagnosed patients, and 47% of patients with recurrent multiple myeloma. Stabilization of disease or partial anti-cancer responses were achieved in over 80% of patients. The major side effect of this treatment was blood clots.
These researchers concluded that the treatment combination DVd-T appears to be very active in the treatment of both newly diagnosed and recurrent multiple myeloma. Long-term follow-up and direct comparisons to stem cell transplants and newer agents such as Velcade® will truly determine the clinical benefit of this treatment regimen. Patients with multiple myeloma, particularly those who are not eligible for a stem cell transplant, may wish to speak with their physician about the risks and benefits of DVd-T or the participation in a clinical trial evaluating other therapeutic options.
Reference: Agrawal NR, Hussein MA, Elson P, et al. Pegalated Doxorubicin (D), Vincristine (V), Reduced Frequency Dexamethasone (D) and Thalidomide (T) (DVd-T) in Newly diagnosed (Nmm) and Relapse/Refractory (Rmm) Multiple Myeloma Patients. Proceedings of the 45th annual meeting of the American Society of Hematology. Blood 2003;102:237a, Abstract #831.