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Combination Therapy Helps to Combat Myeloma
Date:8/27/2008

Adding Velcade to standard drug therapy prolonged survival, study finds

WEDNESDAY, Aug. 27 (HealthDay News) -- Patients with multiple myeloma who could not tolerate high dose chemotherapy lived longer and better by adding the drug Velcade to standard treatment, a new study found.

The finding could make multiple myeloma, a cancer of the blood's plasma cells, a chronic rather than a lethal disease. And it would be particularly valuable to older patients and those with medical conditions that preclude them from receiving high doses of the standard drug therapies melphalan and prednisone, or a transplant, experts said.

"The addition of bortezomib (Velcade) resulted in significant prolongation in time to disease progression with a reduction of 52 percent in risk of progression," said lead researcher Dr. Jesus F. San Miguel, of the Hospital Universitario de Salamanca in Spain. "There was also a significant prolongation of survival, with a 40 percent reduction in the risk of death.

The two-year survival rate among patients taking Velcade with melphalan and prednisone was 82 percent, compared with 69 percent among patients not receiving Velcade, San Miguel said.

The findings are published in the Aug. 28 issue of the New England Journal of Medicine.

San Miguel's team randomly assigned 682 patients with newly diagnosed myeloma to nine six-week cycles of treatment with melphalan and prednisone, or treatment with the two drugs plus Velcade. They found that the time to disease progression among patients receiving Velcade was 24 months, compared with 16.6 months among those getting melphalan and prednisone alone.

Also, 71 percent of the patients receiving Velcade had a partial response to treatment, compared to 35 percent of those receiving melphalan and prednisone alone. And complete responses to treatment were seen among 30 percent of those receiving Velcade, compared to 4 percent for those given Alkeran and prednisone alone.

Responses to treatment continued for 19.9 months among those given Velcade, compared to 13.1 months for those not given the drug.

"The benefit of Velcade was not only observed in good-risk patients, but also in high-risk patients," San Miguel said. "We now have a new standard of care for newly diagnosed patients."

Dr. Bart Kamen, chief medical officer of the Leukemia & Lymphoma Society, thinks this new drug combination could be a real benefit for myeloma patients who aren't eligible for high-dose chemotherapy or a transplant.

"We are in a new era in the treatment of myeloma," Kamen said. "We have a new paradigm of relatively easy drugs compared to the usual chemotherapy, which is adding to quality of life and longevity in myeloma. That's a big deal."

Kamen believes this new treatment and others being developed may make myeloma a chronic condition that can be controlled. "The future, with repetitive doses of lower doses of medicine to control the myeloma, is clearly surfacing," he said.

Dr. Len Lichtenfeld, deputy chief medical officer at the American Cancer Society, agreed that this new treatment is a viable option for patients who are ineligible for standard myeloma treatment.

"It's an exciting time in the treatment of myeloma, and this treatment represents a significant additional option for patients with myeloma who are not candidates for transplant, those who are over 65 or may have other significant illnesses that prevent them from being considered for transplant," Lichtenfeld said.

Until recently, myeloma was a disease with a very limited life expectancy, Lichtenfeld said. "Now, with all the new treatments we have, be it the bone marrow transplant or whether it be the use of the newer drugs, the outlook for myeloma patients has improved considerably," he said.

These treatments don't mean the disease can be cured, Lichtenfeld said. "But we are clearly in a situation where we have made substantial progress," he said.

More information

To learn more about multiple myeloma, visit the American Cancer Society.



SOURCES: Jesus F. San Miguel, M.D., Ph.D., Hospital Universitario de Salamanca, Spain; Bart Kamen, M.D., Ph.D., chief medical officer, Leukemia & Lymphoma Society, White Plains, N.Y.; Len Lichtenfeld, M.D., deputy chief medical officer, American Cancer Society, Atlanta; Aug. 28, 2008, New England Journal of Medicine


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