Velcade® (bortezomib) during induction and maintenance treatment improves survival in newly diagnosed stage II or III multiple myeloma, according to the results of a study published in the Journal of Clinical Oncology.
Multiple myeloma is a cancer of plasma cells, which are a special type of white blood cell that are part of the body’s immune system. Patients with multiple myeloma have increased numbers of abnormal plasma cells that may produce increased quantities of dysfunctional antibodies detectable in the blood and/or urine.
Velcade is a type of targeted drug known as a proteasome inhibitor. It has been shown to provide benefits in the treatment of multiple myeloma and mantle cell lymphoma.
Chemotherapy with vincristine, doxorubicin, and dexamethasone (VAD) has been a standard induction treatment for patients with multiple myeloma. Because treatment with proteasome inhibitors such as Velcade has shown significant activity in patients with relapsed/refractory multiple myeloma, researchers are evaluating this approach in earlier stages of the disease.
A randomized phase III clinical trial evaluated the sustained use of Velcade treatment during induction and maintenance. The study included 827 patients with newly diagnosed symptomatic multiple myeloma who were randomly assigned to receive induction therapy with vincristine, doxorubicin, and dexamethasone (VAD) or Velcade, doxorubicin, and dexamethasone (PAD) followed by high-dose melphalan and autologous stem-cell transplantation. Patients in the VAD group received maintenance therapy with Thalomid® (thalidomide) once per day for two years and patients in the PAD group received maintenance therapy with Velcade once every two weeks for two years.
Complete response was superior in the patients who received PAD induction—31 percent, compared to 15 percent in the VAD group. Velcade maintenance also produced superior complete response—49 percent, compared to 34 percent in the Thalomid group. After a median follow-up of 41 months, progression-free survival (PFS) was 35 months in the PAD group compared to 28 months in the VAD group. Furthermore, overall survival was better in the PAD group.
In high-risk patients presenting with increased creatinine, Velcade significantly improved PFS from a median of 13 months to 30 months and overall survival from a median of 21 months to 54 months.
The researchers concluded that Velcade during induction and maintenance improves complete response, progression-free survival, and overall survival.
Sonneveld P, Schmidt-Wolf IGH, van der Holt B, et al. Bortezomib Induction and maintenance treatment in patients with newly diagnosed multiple myeloma: Results of the randomized phase III HOVON-65/ GMMG-HD4 trial. Journal of Clinical Oncology. 2012; 30(24): 2946-2955.
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