By Peter W. Marks, MD, PhD
Multiple myeloma treatment has advanced rapidly over the past
several years. The introduction of new active agents has, in short order,
transformed the management of affected individuals. Among these new myeloma
drugs are the immune modulators thalidomide and lenalidomide and the proteasome
inhibitor bortezomib. But we do not yet know the best methods for combining
these agents with older therapies, such as melphalan and corticosteroids.
At yesterday’s Plenary Session, Dr. Maria-Victoria Mateos
from the Hospital Universitario de Salamanca in Spain presented results on behalf
of the Spanish Myeloma Group from a prospective, randomized trial in older
patients with newly diagnosed multiple myeloma.
This study compared induction treatment with bortezomib, melphalan, and
prednisone (VMP) to bortezomib, thalidomide (100 mg/day), and prednisone (VTP).
This was followed by maintenance treatment with either bortezomib and
thalidomide (VT) or bortezomib and prednisone (VP).
A total of 260 patients
were enrolled. Individuals who completed six cycles of induction were then
randomized to maintenance with VT or VP for up to three years. The doses and
schedules employed for maintenance included bortezomib 1.3 mg/m2 administered
on days 1, 4, 8, and 11 every three months, in combination with either
continuous thalidomide 50 mg daily (VT) or prednisone 50 mg every other day
One of the notable
findings was that the group treated with VMP induction followed by VT
maintenance had statistically significant better progression-free survival than
those treated with VTP followed by VP. Similar responses were noted in standard
and high-risk groups, indicating that both of these therapeutic regimens can
overcome traditional indicators of poor prognosis.
With respect to adverse events, VMP induction therapy was
associated with a higher incidence of neutropenia and a higher incidence of
infections than VTP. In contrast, VTP therapy was associated with a higher
incidence of peripheral neuropathy than VMP as well as a higher incidence of
serious cardiac events, although the absolute number of such events was small.
Dr. Mateos noted that perhaps the most important finding
was that the poor prognosis of high-risk elderly patients could be overcome
with either treatment regimen. This is good news on the myeloma front, and
there is certain to be more news as the meeting progresses.
Dr. Marks indicated no relevant conflicts of interest.
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