- Switching to proteasome inhibitor-based combination therapy significantly improves PFS in patients with newly diagnosed multiple myeloma (MM) after suboptimal response to first-line immunomodulatory agents.
Why this matters
- These results suggest that chemotherapy agents with different mechanisms of action should be used in combination during initial therapy, if available and tolerable; otherwise, agent class should be switched rapidly after suboptimal response to initial treatment, with the aim of response intensification to prolong PFS.
- See related commentary: Frontline therapy in multiple myeloma: fast start for a long game.
- Researchers in this phase 3 trial studied effects of intensification treatment for newly diagnosed MM with cyclophosphamide, bortezomib, and dexamethasone (CVD) after partial or minimal response to first-line combinations of cyclophosphamide, lenalidomide or thalidomide, and dexamethasone.
- They randomly assigned patients either to CVD (n=289) or no treatment (n=294).
- Funding: Cancer Research UK; Celgene; Amgen; MSD; Myeloma UK.
- Median PFS with CVD was 30 months, and without CVD was 20 months (HR, 0.60; 95% CI, 0.48-0.75; P<.0001>
- 3-year OS with CVD was 77.3%, and without CVD was 78.5% (HR, 0.98; 95% CI, 0.67-1.43; P=.93).
- Most common adverse events with CVD were neutropenia (7%), thrombocytopenia (7%), and anemia (3%), with no treatment-related deaths.
- The trial was open label.