Subcutaneous bortezomib in newly diagnosed patients with multiple myeloma nontransplant eligible: Retrospective evaluation

Subcutaneous bortezomib in newly diagnosed patients with multiple myeloma nontransplant eligible: Retrospective evaluation

Bortezomib-melphalan-prednisone combination is one of the standards of care for nontransplant eligible patients with newly diagnosed multiple myeloma. However, bortezomib intravenous (twice weekly for 4 cycles then weekly for 5 cycles) results in ~13% of patients with grade 3-4 peripheral neuropathy...

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Published in:Seminars in hematology Vol. 55; no. 4; pp. 189 - 196
Main Authors: de Arriba de la Fuente, Felipe, Durán, Maria Soledad, Álvarez, Miguel Ángel, Sanromán, Isabel López, Dios, Ana Maria, Ríos Tamayo, Rafael, García, Ricarda, González, Marta Sonia, Prieto, Elena, Bárez, Abelardo, Escalante, Fernando, Tejedor, Aurelia, Ballesteros, Mónica, Cabañas, Valentín, Capote, Francisco Javier, Couto, Carmen, Garzón, Sebastián, González-Pardo, Miriam, Mateos Manteca, Maria Victoria
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01-10-2018
Subjects:
Aged
Aged, 80 and over
Antineoplastic Agents - pharmacology
Antineoplastic Agents - therapeutic use
Bortezomib
Bortezomib - pharmacology
Bortezomib - therapeutic use
Effectiveness
Female
Humans
Injections, Subcutaneous
Intensive treatment
Male
Middle Aged
Multiple Myeloma - drug therapy
Optimized treatment
Real-world setting
Retrospective Studies
Safety
Subcutaneous
Treatment Outcome
Real-world setting
Intensive treatment
Bortezomib
Effectiveness
Optimized treatment
Subcutaneous
Safety
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Summary:Bortezomib-melphalan-prednisone combination is one of the standards of care for nontransplant eligible patients with newly diagnosed multiple myeloma. However, bortezomib intravenous (twice weekly for 4 cycles then weekly for 5 cycles) results in ~13% of patients with grade 3-4 peripheral neuropathy. Bortezomib subcutaneous (SQ) and weekly delivery, improves tolerability without impairment of efficacy. The aim of this study was to evaluate the safety and effectiveness of SQ bortezomib-based combinations in nontransplant eligible patients with newly diagnosed myeloma in a real-world setting. A total of 135 patients (median age [range] = 76 [58-89], International Staging System-III = 54%, median follow-up = 14.8 months [1-40], Intensive group [twice weekly bortezomib] = 65%, Optimized group [weekly bortezomib] = 35%) were included and evaluable for safety, whereas 121 were evaluable for effectiveness. Overall response rate (95% CI) was 61% (53%, 71%) (complete response = 27%, very good partial response = 13%, and partial response = 21%) and median progression-free survival was 22.2 months (95% CI: 16.1-not reached). The 3-year overall survival was 75%. The most frequent grade 3-4 adverse events were thrombocytopenia (18%), neutropenia (17%), and anemia (11%). Peripheral neuropathy of any grade was observed in 44% of patients (2% with grade 3). Comparison between regimens (Intensive vs Optimized) showed similar overall response rate (57% vs 70%) and PFS (25 vs 19 months). A similar safety profile was observed between regimens. Thus, SQ bortezomib showed similar effectiveness and better tolerability as compared with results from intravenous bortezomib studies, and showing no differences either in effectiveness or safety in different bortezomib-based combinations.
Bibliography:ObjectType-Article-2
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ISSN:0037-1963
1532-8686
DOI:10.1053/j.seminhematol.2017.09.002