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FROM THE LITERATURE
Myeloma
A New Standard of Care in Multiple Myeloma?
Treatment with melphalan plus prednisone has been a standard of
care for non-transplant candidates with newly diagnosed multiple myeloma for more
than four decades. During the past 10 years, high-dose therapy with hematopoietic
stem-cell transplantation (SCT) has become the preferred therapy for patients under
the age of 65 years, but older patients and patients with significant co-existing
illnesses usually cannot tolerate this treatment. The median age at diagnosis of
myeloma is approximately 70 years, therefore more than half the patients with newly
diagnosed myeloma may not be eligible for high-dose therapy. For these patients,
improved treatment is needed.
Results of a phase III trial comparing melphalan + prednisone vs melphalan + prednisone
plus bortezomib (Velcade®) in this patient population (n=682) demonstrate that the
addition of bortezomib significantly improves the median time to progression (TTP),
the primary endpoint by 7.4 months (HR=0.48; p<0.001). The bortezomib group was
superior to the melphalan + prednisone for the following: partial response or better,
71% vs 35%; CR rate, 30% vs 4% (p<0.001); median duration of response, 19.9 months
vs 13.1 months; overall survival, HR of 0.61 (p=0.008).
This study demonstrates the superior efficacy of bortezomib plus melphalan and prednisone
compared to melphalan and prednisone alone for the front-line treatment of patients
who are 65 years of age or older and cannot receive more aggressive therapy. The
authors state that since superior efficacy in the treatment of myeloma has now been
shown with bortezomib or thalidomide in combination with melphalan and prednisone,
the two-drug combination should no longer be considered the standard of care in
patients 65 years of age or older.
San Miguel JF, et al. Bortezomib plus melphalan and prednisone for initial treatment
of multiple myeloma. N Engl J Med. 2008; 359: 906-17
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