Abstract
In patients with multiple myeloma (MM), once-weekly intravenous injection or twice-weekly subcutaneous injection (SC) of bortezomib has been proven to offer non-inferior efficacy to standard twice-weekly intravenous administration, with an improved safety profile. However, whether once-weekly SC bortezomib can further reduce the incidence rate of peripheral neuropathy (PN) and not compromise the efficacy remains to be investigated. 25 patients of MM treated with once-weekly SC bortezomib were reviewed in this study. The median treatment cycles were 4 (range, 2-9 cycles). Complete response (CR) rate was 52%, ≥very good partial response (VGPR) rate was 72%, and ≥partial response (PR) rate was 84%. 1-year and 2-year PFS rate was 63.0% and 34.3%, respectively, and 2-year OS rate was 100%. Any grade of PN was reported in 9 patients (36.0%), with 7 patients (28.0%) had grade 1 PN, and 2 patients (8.0%) had grade 2 PN. No patients reported grade 3/4 PN in this cohort. In conclusion, once-weekly subcutaneous administration of bortezomib offers excellent efficacy with a further improved safety profile, especially with regard to PN. It needs to be validated in future prospective randomized trials.
Highlights
Multiple myeloma (MM) is a fatal plasma cell disease that accounts for 1% of all cancers and 10% of hematological malignancies
Previous studies have confirmed the excellent efficacy of bortezomib in the treatment of multiple myeloma both in newly diagnosed patients and relapsed/refractory patients (Raab et al, 2009; Reeder et al, 2010; Bringhen et al, 2010; Engelhardt et al, 2010; Sonneveld et al, 2012; Nooka et al, 2013; Sonneveld et al, 2013)
Several clinical trials have evaluated the benefit of prolonging the administration interval of bortezomib as once-weekly intravenous injection, and concluded that this strategy can significantly reduce the incidence rate of peripheral neuropathy (PN), and did not appear to influence the efficacy (Bringhen et al, 2010; Reeder et al, 2010)
Summary
Multiple myeloma (MM) is a fatal plasma cell disease that accounts for 1% of all cancers and 10% of hematological malignancies It primarily affects older individuals, and the median age at diagnosis is 70 years and nearly two-thirds of MM patients are more than 65 years of age when they are first diagnosed (Sonneveld et al, 2013). The first recommended dose and schedule of bortezomib is 1.3 mg/m2 administered as a bolus intravenous injection (IV) on days 1, 4, 8, and 11 of 21-day cycles. This regimen is active and well tolerated. Whether once-weekly SC bortezomib can further reduce the incidence rate of PN and not compromise the efficacy remains to be investigated. This strategy of bortezomib administration has been used since 2012 in our center, and we reported the efficacy and safety results of a cohort of 25 patients with MM who received once-weekly SC bortezomib
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