Four drugs may be better than three in older myeloma patients

BY MELISSA WEBER | DECEMBER 6, 2009

A four-drug combo with Velcade (bortezomib) followed by maintenance therapy resulted in better response rates and less neuropathy compared with the standard three-drug Velcade combo in newly diagnosed multiple myeloma patients who are over age 65.

The phase 3 study, presented today at the annual meeting of the American Society of Hematology, compared a combination of Velcade, melphalan, prednisone, and thalidomide (VMPT) followed by a maintenance regimen of Velcade and thalidomide versus the current standard of care--Velcade, melphalan, and prednisone (VMP). The intensity of both VMPT and VMP was reduced from nine six-week cycles to nine five-week cycles, with Velcade given weekly.

While roughly one-quarter (24 percent) of patients in the VMP arm had complete disappearance of cancer, known as a complete response, 38 percent of patients on VMPT had a complete response. Plus, for 60 percent of VMPT patients, the cancer had not progressed after three years, compared with 42 percent of VMP patients. Investigators said longer follow-up is needed to assess overall survival.

The weekly infusion of Velcade (as opposed to twice a week) resulted in a significantly reduced incidence of peripheral neuropathy, a debilitating side effect that affects the nerves, without affecting response or progression-free survival. Researchers noted a higher incidence of neutropenia and heart complications in the VMPT arm.

A Spanish study presented at the meeting also looked at different Velcade combinations in older myeloma patients. Although each trial used a different approach, both used four drugs in the end. You can read about that study in CURE's Winter issue, which drops in a couple weeks, or sign up for one of our blood cancer e-newsletters to get the latest news from ASH.