Visual abstract | Venetoclax in patients with multiple myeloma who are receiving bortezomib and dexamethasone as standard therapy (BELLINI)

Multiple myeloma (MM) cells are typified by high levels of antiapoptotic proteins, such as BCL-2.1 Use of BCL-2 inhibitors, such as venetoclax, induces apoptosis. When combined with bortezomib and dexamethasone, the BELLINI phase III study demonstrated that venetoclax improved response rates and progression-free survival (PFS) in patients with relapsed/refractory MM (RRMM), though increased mortality was observed in the venetoclax group (baseline characteristics are detailed here). At the 63rd American Society of Hematology (ASH) Meeting and Exposition, Kumar¹ presented updated safety and efficacy data from the final prespecified overall survival (OS) analysis of the BELLINI trial. This is summarized in the visual abstract presented.

The addition of venetoclax to bortezomib and dexamethasone demonstrated improved PFS after 45.6 months median follow-up.¹  This was more marked in patients with t(11;14) or BCL2high expression and standard-risk cytogenetics. Although the combination resulted in increased early mortality compared with the control arm, the OS hazard ratio improved over time. Interestingly, patients with t(11;14) or BCL2high expression did not seem to be at increased risk of early mortality. These data support a biomarker-driven approach to venetoclax treatment in RRMM.¹ 

Details of other ongoing trials with venetoclax in MM can be found here.

Visual abstract