Less intensive drug schedule as effective as standard treatment for blood cancer

Aug 23, 2010

A less intensive bortezomib-based regimen (given once instead of twice per week) followed by maintenance therapy, is as effective as the standard treatment for elderly patients with multiple myeloma, but with fewer serious side effects, and will be a valuable treatment option in these patients, according to an Article published Online First in The Lancet Oncology.

For more than 30 years, melphalan plus prednisone has been the mainstay of treatment for elderly patients with multiple myeloma. However, the addition of new agents such as thalidomide, bortezomib, and have improved response rates and extended life expectancies, but often with increased adverse effects. In 2008, the VISTA trial showed that the combination of bortezomib, melphalan, and prednisone was significantly better than the standard treatment of melphalan and prednisone alone, but toxic effects were high.

In this study, a team of researchers from Spain led by Maria-Victoria Mateos from the University Hospital of Salamanca investigated whether a less intensive bortezomib-based regimen of induction therapy supplemented with maintenance treatments could reduce toxic effects while maintaining efficacy.

The researchers designed a two-stage randomised trial to establish whether an alkylating agent (melphalan) or an immunomodulatory drug (thalidomide) would work better with bortezomib. 260 patients aged 65 years or older with untreated myeloma were randomly assigned to initial treatment with six cycles of reduced dosage bortezomib plus melphalan and prednisone (VMP; 130), or reduced dosage bortezomib plus thalidomide and prednisone (VTP; 130). Patients who completed induction therapy were subsequently randomly assigned to with bortezomib and prednisone (VP; 87) or bortezomib and (VT; 91) for up to three years.

Findings showed that the less intensive VMP and VTP induction regimens were effective and well tolerated with similar response rates —81% patients in the VTP group and 80% in the VMP group, including 36 (28%) VTP patients and 26 (20%) VMP patients had complete remission.

Treatment with VTP resulted in more serious adverse events (40 vs 20) and discontinuations (22 vs 15) than with VMP. Of the most common side effects (grade 3 or worse), infections (1% vs 7%) were more frequent with VMP while cardiac events (8% vs 0) and peripheral neuropathy (nerve pain [9% vs 7%]) were more common in the VTP group.

Importantly, this less intensive schedule was associated with a reduction in the incidence of grade 3 or higher peripheral neuropathy from 13% (in the previous VISTA trial) to 8%, and in gastrointestinal symptoms from 19% to 4%, while maintaining efficacy.

Additionally, maintenance therapy resulted in a substantial improvement in patient responses with good tolerability, increasing complete response from 23% to 42%, with no significant differences in response rates between the two regimens.

The authors conclude: "The therapeutic approach of reduced-intensity induction, followed by maintenance, with bortezomib-based therapy…is a safe and effective treatment for elderly patients with multiple myeloma."

In a Comment, S Vincent Rajkumar from the Mayo Clinic, Rochester, USA, says that this is an important study that immediately affects clinical practice by providing a safer dosing for . However, he points out that there are now five regimens for treatment of elderly patients with newly diagnosed shown to be effective in randomised trials, but no data on how these regimens compare: "We are faced with the challenge of selecting from treatments with significantly different side-effect profiles and route of administration without the benefit of randomised trials."

Explore further: Spicy treatment the answer to aggressive cancer?

More information: www.thelancet.com/journals/lanonc/article/PIIS1470-2045(10)70187-X/abstract

Related Stories

Drug shows promise as new treatment for gut tumor

Jan 11, 2010

A drug that is already an approved therapy for some cancers also might be an effective secondary treatment for a rare tumor of the gastrointestinal tract, according to a team led by researchers from the University of Pittsburgh ...

Recommended for you

Spicy treatment the answer to aggressive cancer?

Jul 03, 2015

It has been treasured by food lovers for thousands of years for its rich golden colour, peppery flavour and mustardy aroma…and now turmeric may also have a role in fighting cancer.

Cancer survivors who smoke perceive less risk from tobacco

Jul 02, 2015

Cancer survivors who smoke report fewer negative opinions about smoking, have more barriers to quitting, and are around other smokers more often than survivors who had quit before or after their diagnosis, according to a ...

Melanoma mutation rewires cell metabolism

Jul 02, 2015

A mutation found in most melanomas rewires cancer cells' metabolism, making them dependent on a ketogenesis enzyme, researchers at Winship Cancer Institute of Emory University have discovered.

User comments : 0

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.