Efficacy and safety of once-weekly bortezomib in multiple myeloma patients

Bringhen, Sara; Larocca, Alessandra; Rossi, Davide; Cavalli, Maide; Genuardi, Mariella; Ria, Roberto; Gentili, Silvia; Patriarca, Francesca; Nozzoli, Chiara; Levi, Anna; Guglielmelli, Tommasina; Benevolo, Giulia; Callea, Vincenzo; Rizzo, Vincenzo; Cangialosi, Clotilde; Musto, Pellegrino; Rosa, Luca De; Liberati, Anna Marina; Grasso, Mariella; Falcone, Antonietta; Evangelista, Andrea; Cavo, Michèle; Gaïdano, Gianluca; Boccadoro, Mario; Palumbo, Antônio

doi:10.1182/blood-2010-07-294983

Cited by 348 publications

(208 citation statements)

References 34 publications

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“…When bortezomib schedule was changed from twice-to onceweekly administration, the incidence of non-hematologic grade 3-4 adverse events decreased from 51% to 36% (p = 0.003), particularly peripheral neuropathy (from 16% to 3%, p < 0.001). [10] and [50] This modification did not affect efficacy, as the cumulative delivered dose of bortezomib was similar. 50 Therefore, VMPT-VT with once-weekly bortezomib seems a valid alternative for elderly patients, especially for those 65-75 years of age.…”

Section: Continuous Treatmentmentioning

confidence: 99%

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Management of older adults with multiple myeloma

Palumbo¹,

Mina²

2013

Blood Reviews

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Two-thirds of patients with multiple myeloma are aged 65 years or more and the prevalence of multiple myeloma in elderly patients is expected to rise in the next future. Patients older than 65 years are usually considered ineligible for transplantation. The introduction of novel agents, such as the immunomodulatory drugs thalidomide and lenalidomide and the proteasome inhibitor bortezomib, combined with conventional chemotherapy, has radically changed the treatment paradigm of elderly patients and improved outcome. A sequential approach, consisting of an induction regimen associated with a high rate of complete response, followed by consolidation/maintenance therapy, induces a profound cytoreduction and delays relapse, thus improving survival. Novel agents associated with reduced-intensity autologous transplant showed to be safe and effective in fit elderly patients. Patients older than 75 years or vulnerable ones are more susceptible to adverse events that negatively affect treatment adherence and outcome. In this setting, less toxic regimens and appropriate dose reductions should be adopted. Here we provide an overview of novel agent-based treatment strategies for elderly patients with multiple myeloma.

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Section: Continuous Treatmentmentioning

confidence: 99%

“…[10] and [50] This modification did not affect efficacy, as the cumulative delivered dose of bortezomib was similar. 50 Therefore, VMPT-VT with once-weekly bortezomib seems a valid alternative for elderly patients, especially for those 65-75 years of age.…”

Section: Continuous Treatmentmentioning

confidence: 99%

Management of older adults with multiple myeloma

Palumbo¹,

Mina²

2013

Blood Reviews

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“…There was a significantly reduced overall incidence of grade 3-4 peripheral neuropathy (8% versus 28%, P < 0.001) in the onceweekly versus twice-weekly group, without any significant change in efficacy. (28) Of note, this is the first study to show the superiority of a 4-drug combination followed by maintenance over the most recent standard therapy VMP. Moreover, this study confirmed the higher efficacy and good tolerability of the once-weekly schedule of bortezomib.…”

Section: Bortezomib Plus Thalidomide Based Therapiesmentioning

confidence: 85%

Management of older patients with multiple myeloma

Gay

Palumbo

2011

Blood Reviews

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For many years, the oral combination melphalan-prednisone (MP) has been considered the standard of care for patients with multiple myeloma (MM) not eligible for autologous stem cell transplantation. In the era of novel agents, the introduction of immunomodulatory drugs and proteasome inhibitors has challenged the role of MP and lead to new standards of care for this disease. Five randomized phase III studies compared the traditional MP with the MP plus thalidomide (MPT). All these studies showed a prolonged time to progression (TTP) with the 3-drug combination. However, in only two of these trials this advantage translated into an improvement in overall survival (OS). In another randomized trial, MP plus bortezomib (VMP) was correlated with an increase in both TTP and OS compared with MP. Preliminary data showed the

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“…Four‐weekly CyBorD treatments were counted as 1 cycle. A regimen that consisted of once‐weekly administration of 1.5 mg/m 2 bortezomib with 20 mg dexamethasone was tried in one patient, because of cyclophosphamide‐induced cytopenia, and because recent reports had shown that once‐weekly bortezomib had similar efficacy with reduced adverse events 17, 18…”

Section: Methodsmentioning

confidence: 99%

Bortezomib treatment for severe refractory anti‐NMDA receptor encephalitis

Shin

Lee

Kim

et al. 2018

Ann Clin Transl Neurol

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ObjectiveTo evaluate the therapeutic potential of bortezomib, a proteasome inhibitor that target plasma cells, in order to revive stalled recovery in patients with anti‐N‐methyl‐d‐aspartate (NMDA) receptor encephalitis who remain bedridden even after aggressive immunotherapy.MethodsWe consecutively enrolled patients with anti‐NMDA receptor encephalitis who remained bedridden after first‐line immunotherapy (steroids and intravenous immunoglobulin), second‐line immunotherapy (rituximab), and tocilizumab treatment, and treated them with subcutaneous bortezomib. Clinical response, functional recovery, and changes in antibody titer in the serum and cerebrospinal fluid were measured.ResultsBefore the bortezomib treatment, the five patients with severe refractory anti‐NMDA receptor encephalitis were in a vegetative state. During the 8 months of follow‐up period, three patients improved to minimally conscious states within 2 months of bortezomib treatment, one failed to improve from a vegetative state. However, no patient achieved functional recovery as measured by the modified Rankin Scale score (mRS). Three patients advanced to a cyclophosphamide with bortezomib and dexamethasone regimen, which only resulted in additional adverse events, without mRS improvement. Among the four patients whose antibody titer was followed, two demonstrated a twofold decrease in the antibody titer in serum and/or cerebrospinal fluid after 2 cycles of bortezomib.InterpretationAlthough there were some improvements in severe refractory patients, clinical response to bortezomib was limited and not clearly distinguishable from the natural course of the disease. The clinical benefit of bortezomib in recent studies requires further validation in different clinical settings.

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Efficacy and safety of once-weekly bortezomib in multiple myeloma patients

Cited by 348 publications

References 34 publications

Management of older adults with multiple myeloma

Management of older adults with multiple myeloma

Management of older patients with multiple myeloma

Bortezomib treatment for severe refractory anti‐NMDA receptor encephalitis

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