According to results recently published in the New England Journal of Medicine, the agent Velcade® (bortezomib) had greater anti-cancer responses and survival times than high-dose dexamethasone in patients with recurrent multiple myeloma.
Multiple myeloma is a cancer involving important immune (infection-fighting) cells called plasma cells. These cells aid the body in fighting infection by producing specialized proteins called antibodies that target and 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 necessary for normal production of blood cells and immune functions. This 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. Additionally, the cancerous plasma cells secrete dysfunctional antibodies, referred to as M proteins, which can be measured in the blood. If multiple myeloma returns following therapy, it is referred to as recurrent. Effective and easily tolerated treatment options are limited for patients with recurrent multiple myeloma.
Velcade offers a new avenue for treatment-as a proteosome inhibitor, it interferes with the growth and survival of cancer cells responsible for recurrent multiple myeloma. Proteosomes are proteins found in virtually all cells that are responsible for the breakdown and re-use of other proteins in a cell. Proteosomes regulate several aspects of cellular activity that activate survival pathways of a cell. Velcade has demonstrated an inhibitory effect on cellular survival through its activity on proteosomes. The drug also makes cancer cells more vulnerable to the killing effects of chemotherapy in refractory myeloma cells. Evaluation of Velcade continues in the treatment of different stages of multiple myeloma, as well as in the treatment of other types of cancers.
Researchers affiliated with the Assessment of Proteosome Inhibition for Extending Remissions (APEX) Investigators recently conducted a large clinical trial directly comparing Velcade to high-dose dexamethasone (a steroid regimen that is routinely used in the treatment of multiple myeloma) in the treatment of recurrent multiple myeloma. This trial included 669 patients who had received one to three previous treatment regimens for their disease. Patients were then treated either with Velcade or high-dose dexamethasone. Overall, treatment with Velcade improved anti-cancer responses, progression-free survival and overall survival significantly more than high-dose dexamethasone: Anti-cancer responses were achieved in 38 percent of patients treated with Velcade, while only 18 percent of patients treated with high-dose dexamethasone responded. The average time to cancer progression was also lengthened for Velcade patients-6.2 months versus 3.5 months for those treated with dexamethasone. As well, 80 percent of patients treated with Velcade were still alive at one year, while only 60 percent of patients treated with dexamethasone survived to that point.
The researchers concluded that Velcade is superior to high-dose dexamethasone for patients with recurrent multiple myeloma in terms of cancer progression and overall survival. Patients with recurrent multiple myeloma may wish to speak with their physician about their individual risks and benefits of treatment with Velcade.
Reference: Richandson PG, Sonneveld P, Schuster MW, et al. Bortezomib or high-dose dexamethasone for relapsed multiple myeloma. New England Journal of Medicine. 2005;352:2487-2498.
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