Four drugs may be better than three in older myeloma patients

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.