Bortezomib Induction Associated with Greater Survival in Multiple Myeloma

The use of bortezomib-based treatment regimens is associated with improved survival when used as induction therapy for multiple myeloma. These results were recently published in the Journal of Clinical Oncology.

Multiple myeloma (MM) is type of cancer that originates in immune cells. A common type of treatment for MM is a stem cell transplant, in which high doses of chemotherapy and/or radiation are used. Although the high doses kill more cancer cells than standard doses, they also are associated with side effects, such as low levels of blood cells.

Due to the low levels of blood cells, patients remain at risk of life-threatening infections, bleeding and anemia. Therefore, stem cells are infused into the patient following treatment. The stem cells may be from the patient, collected prior to therapy, or they may be from a matched donor.

Induction therapy is treatment given to patients prior to the high-dose therapy in an attempt to lower levels of cancer cells without toxic side effects. Researchers continuously explore novel options for the treatment of MM, including optimal induction regimens.

Bortezomib is an agent that is commonly used for MM as part of an induction therapy regimen. Researchers recently evaluated data from phase III trials that compared induction regimens either containing bortezomib or not containing bortezomib among patients with MM.

The data included 1,572 patients who had not received prior therapy for their MM and all were eligible for a stem cell transplant.

Median survival without progression of disease (PFS) following the transplant was nearly 36 months among patients who received bortezomib-based induction therapy, compared with 28.6 for those who received non-bortezomib based induction therapy.
At 3 years following the stem cell transplant, overall survival was 79.7% for those treated with bortezomib, compared with 74.7% for those not treated with bortezomib.
The rate of death during induction therapy was similar between the two groups of patients (3% for those treated with bortezomib versus 4% for those not treated with bortezomib).
Rates of peripheral neuropathy were higher among those treated with bortezomib.
The researchers concluded that “Bortezomib-based induction results in significant improvements in response and PFS/ [overall survival] compared with nonbortezomib-based induction and is generally well tolerated, with a higher rate of peripheral neuropathy but no apparent increase in risk of death during induction.”

Reference: Sonneveld P, Goldschmidt H, Rosinol L, et al. Bortezomib-based versus nonbortezomib-based induction treatment before autologous stem-cell transplantation in patients with previously untreated multiple myeloma: a meta-analysis of phase III randomized, controlled trials. Journal of Clinical Oncology. 2013;31(26):3279-3287.