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Consolidation therapy with thalidomide and prednisolone (TP) in patients with newly diagnosed multiple myeloma (NDMM), post-autologous stem cell transplant (ASCT) is the standard of care in Australia.1 In other studies, consolidation with bortezomib (Velcade®), a proteasome inhibitor (PI), has been shown to deepen responses and prolong progression free survival (PFS) in patients with NDMM following ASCT. Therefore, it was hypothesized that adding bortezomib to the TP consolidation regimen, may increase patient outcomes.
In this study by Noemi Horvath, Royal Adelaide Hospital, AUS, and colleagues, patients with NDMM were treated with an induction regimen of bortezomib, cyclophosphamide and dexamethasone, proceeded to ASCT, and then received consolidation therapy of bortezomib + TP (VTP), or TP alone. The results of their randomized, open-label, phase III study, VCAT (NCT01539083), were recently published in Leukemia and Lymphoma.2
Therapy pathway:
All results are given as VTP versus TP
Efficacy
Survival:
Safety
During VCD induction (N = 254):
During consolidation:
Patients in this study were treated with the same induction therapy; therefore, upon starting consolidation all patients were IMid-naïve but bortezomib-exposed. It is possible that the improvements in efficacy were due to the exposure to thalidomide (an IMiD), explaining the similarity in the increases of response. Investigators had hypothesized an improvement of 15%, which was not reached.
It is possible that the number of cycles of induction therapy or the route of administration of bortezomib may have influenced the ≥VGPR rate. Additionally, whilst patients were recruited from Australia, China and Korea, 79% were white, meaning the patient population was not representative of all patients with NDMM.
With regards to safety, the addition of bortezomib was well tolerated and no new safety concerns emerged; with both VTP and TP regimens well-tolerated. However, a higher proportion of patients discontinued treatment due to TEAEs in the VTP group. The rate of hematologic AEs was low.
During consolidation, the percentage of patients achieving a VGPR or better was improved in both treatment arms and despite an improvement trend in the ≥VGPR rate after 12 months in the VTP arm, statistical significance was not reached. No statistically significant differences were observed in the secondary endpoints (PFS, DFS and HRQoL). The VTP regimen investigated here is not recommended compared to TP alone for patients with NDMM who receive VCD induction and ASCT.
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