New Treatment Strategy Benefits Older Myeloma Patients

The key findings from a phase 3 Spanish study are three-fold: less aggressive initial (induction) therapy with once-weekly—rather than twice-weekly—Velcade (bortezomib) was effective; melphalan outdid thalidomide as a partner to Velcade; and following induction with maintenance therapy may be the best approach for treating multiple myeloma patients over 65 who haven’t received previous treatment.

The key findings from a phase 3 Spanish study are three-fold: less aggressive initial (induction) therapy with once-weekly—rather than twice-weekly—Velcade (bortezomib) was effective; melphalan outdid thalidomide as a partner to Velcade; and following induction with maintenance therapy may be the best approach for treating multiple myeloma patients over 65 who haven’t received previous treatment.

In the two-part study, 260 patients were randomized to receive either Velcade, melphalan, and prednisone (VMP) or Velcade, thalidomide, and prednisone (VTP). Both combinations yielded a similarly high overall response rate (the percentage of patients whose cancer shrinks or disappears after treatment), reaching 80 percent for VMP and 81 percent for VTP. However, a clear difference emerged when looking at side effects: Nine percent of patients in the VTP arm experienced severe peripheral neuropathy, compared with 5 percent of patients on VMP, and VTP was more toxic to the heart, with 8.5 percent of patients developing cardiac toxicity, compared with none in the VMP group. The VMP group, however, had more cases of infection and severely low white blood cell and platelet counts.

After VMP or VTP induction, patients received maintenance therapy with Velcade plus either thalidomide (VT) or prednisone (VP) for up to three years. Despite no significant difference between the two regimens in terms of safety or response, the addition of maintenance therapy increased the complete response rate from 23 percent after induction treatment to 42 percent after maintenance therapy, and VMP followed by VT was the winner overall.