REAL WORLD EXPERIENCE OF BORTEZOMIB RE-TREATMENT FOR PATIENTS WITH MULTIPLE MYELOMA AT FIRST RELAPSE
(Abstract release date: 05/19/16)
EHA Library. Reyal Y. 06/09/16; 134905; PB2005
Dr. Yasmin Reyal
Contributions
Contributions
Abstract
Abstract: PB2005
Type: Publication Only
Background
In the United Kingdom (UK), bortezomib (Velcade, Janssen) based triplet regimens are commonly used as first line therapy for both transplant eligible and ineligible patients. The efficacy of re-treatment with bortezomib monotherapy or bortezomib plus dexamethasone in subsequent lines of therapy has been previously reported. However there are limited data on re-treatment at first relapse, particularly with bortezomib-based triplet regimens which are more commonly used in current practice.
Aims
This study aimed to evaluate the efficacy of bortezomib triplet regimens at first relapse in patients previously treated with first line bortezomib. The safety of bortezomib as re-treatment was also assessed.
Methods
This was a retrospective analysis of MM patients at first relapse treated with bortezomib, who had also received bortezomib as first line therapy. Twenty three sequential patients from a single UK center who had achieved at least a partial response (≥PR) and a treatment free interval (TFI) of a minimum of 60 days from first line bortezomib treatment (i.e. not refractory) were identified. Response to treatment and disease progression were defined by the International Myeloma Working Group criteria.
Results
A triplet bortezomib combination was used as first line therapy in 78% of patients (n=18/23) with a median of five cycles given (range 4-8). No patient received maintenance therapy. The median time to best response (TTBR) was 3.5 months (range 0.7-9.0) and the median duration of response (DOR) was 14.9 months (range 4.7-44.5). The overall response rate (ORR) to bortezomib at first relapse was 87% (PR 39%, VGPR 35%, CR 13%). The median TTBR was 4.1 months (range 0.7 -15.0) and median DOR was 11.5 months (range 1.0-18.5). After first line bortezomib, the median time to progression (TTP) was 18.9 months (range 7.3-49.6) whilst it was 14.4 months (range 1.4-16.6) at first relapse. The median TFI was 20.7 months (range 2.0-62.8) after first line bortezomib and 10.4 months (range 1.0-14.0) after bortezomib re-treatment. Ten patients received ASCT at first line compared to 11 at first relapse.Treatment-related toxicity was also evaluated. At first line, eleven patients (48%) experienced peripheral neuropathy (PN) (all grade 1). There were three (13%) grade 3-4 non-hematological adverse events (AE), which were all infections. All but one patient restarted bortezomib at full dose at relapse. Only two patients (11%) required a subsequent dose reduction (for PN). Eleven patients (61%) experienced PN with first relapse treatment (all grade 1-2). There were two grade 3 AEs (diarrhoea and febrile neutropenia). All patients who relapsed for a second time were able to proceed to a third line regimen which was most commonly lenalidomide and dexamethasone.
Conclusion
This single center study in real life patients demonstrates that bortezomib combinations used at first line and sequentially at first relapse represent a valid treatment strategy for selected patients.
Session topic: E-poster
Keyword(s): Bortezomib, Myeloma, Relapse, Retreatment
Type: Publication Only
Background
In the United Kingdom (UK), bortezomib (Velcade, Janssen) based triplet regimens are commonly used as first line therapy for both transplant eligible and ineligible patients. The efficacy of re-treatment with bortezomib monotherapy or bortezomib plus dexamethasone in subsequent lines of therapy has been previously reported. However there are limited data on re-treatment at first relapse, particularly with bortezomib-based triplet regimens which are more commonly used in current practice.
Aims
This study aimed to evaluate the efficacy of bortezomib triplet regimens at first relapse in patients previously treated with first line bortezomib. The safety of bortezomib as re-treatment was also assessed.
Methods
This was a retrospective analysis of MM patients at first relapse treated with bortezomib, who had also received bortezomib as first line therapy. Twenty three sequential patients from a single UK center who had achieved at least a partial response (≥PR) and a treatment free interval (TFI) of a minimum of 60 days from first line bortezomib treatment (i.e. not refractory) were identified. Response to treatment and disease progression were defined by the International Myeloma Working Group criteria.
Results
A triplet bortezomib combination was used as first line therapy in 78% of patients (n=18/23) with a median of five cycles given (range 4-8). No patient received maintenance therapy. The median time to best response (TTBR) was 3.5 months (range 0.7-9.0) and the median duration of response (DOR) was 14.9 months (range 4.7-44.5). The overall response rate (ORR) to bortezomib at first relapse was 87% (PR 39%, VGPR 35%, CR 13%). The median TTBR was 4.1 months (range 0.7 -15.0) and median DOR was 11.5 months (range 1.0-18.5). After first line bortezomib, the median time to progression (TTP) was 18.9 months (range 7.3-49.6) whilst it was 14.4 months (range 1.4-16.6) at first relapse. The median TFI was 20.7 months (range 2.0-62.8) after first line bortezomib and 10.4 months (range 1.0-14.0) after bortezomib re-treatment. Ten patients received ASCT at first line compared to 11 at first relapse.Treatment-related toxicity was also evaluated. At first line, eleven patients (48%) experienced peripheral neuropathy (PN) (all grade 1). There were three (13%) grade 3-4 non-hematological adverse events (AE), which were all infections. All but one patient restarted bortezomib at full dose at relapse. Only two patients (11%) required a subsequent dose reduction (for PN). Eleven patients (61%) experienced PN with first relapse treatment (all grade 1-2). There were two grade 3 AEs (diarrhoea and febrile neutropenia). All patients who relapsed for a second time were able to proceed to a third line regimen which was most commonly lenalidomide and dexamethasone.
Conclusion
This single center study in real life patients demonstrates that bortezomib combinations used at first line and sequentially at first relapse represent a valid treatment strategy for selected patients.
Session topic: E-poster
Keyword(s): Bortezomib, Myeloma, Relapse, Retreatment
Abstract: PB2005
Type: Publication Only
Background
In the United Kingdom (UK), bortezomib (Velcade, Janssen) based triplet regimens are commonly used as first line therapy for both transplant eligible and ineligible patients. The efficacy of re-treatment with bortezomib monotherapy or bortezomib plus dexamethasone in subsequent lines of therapy has been previously reported. However there are limited data on re-treatment at first relapse, particularly with bortezomib-based triplet regimens which are more commonly used in current practice.
Aims
This study aimed to evaluate the efficacy of bortezomib triplet regimens at first relapse in patients previously treated with first line bortezomib. The safety of bortezomib as re-treatment was also assessed.
Methods
This was a retrospective analysis of MM patients at first relapse treated with bortezomib, who had also received bortezomib as first line therapy. Twenty three sequential patients from a single UK center who had achieved at least a partial response (≥PR) and a treatment free interval (TFI) of a minimum of 60 days from first line bortezomib treatment (i.e. not refractory) were identified. Response to treatment and disease progression were defined by the International Myeloma Working Group criteria.
Results
A triplet bortezomib combination was used as first line therapy in 78% of patients (n=18/23) with a median of five cycles given (range 4-8). No patient received maintenance therapy. The median time to best response (TTBR) was 3.5 months (range 0.7-9.0) and the median duration of response (DOR) was 14.9 months (range 4.7-44.5). The overall response rate (ORR) to bortezomib at first relapse was 87% (PR 39%, VGPR 35%, CR 13%). The median TTBR was 4.1 months (range 0.7 -15.0) and median DOR was 11.5 months (range 1.0-18.5). After first line bortezomib, the median time to progression (TTP) was 18.9 months (range 7.3-49.6) whilst it was 14.4 months (range 1.4-16.6) at first relapse. The median TFI was 20.7 months (range 2.0-62.8) after first line bortezomib and 10.4 months (range 1.0-14.0) after bortezomib re-treatment. Ten patients received ASCT at first line compared to 11 at first relapse.Treatment-related toxicity was also evaluated. At first line, eleven patients (48%) experienced peripheral neuropathy (PN) (all grade 1). There were three (13%) grade 3-4 non-hematological adverse events (AE), which were all infections. All but one patient restarted bortezomib at full dose at relapse. Only two patients (11%) required a subsequent dose reduction (for PN). Eleven patients (61%) experienced PN with first relapse treatment (all grade 1-2). There were two grade 3 AEs (diarrhoea and febrile neutropenia). All patients who relapsed for a second time were able to proceed to a third line regimen which was most commonly lenalidomide and dexamethasone.
Conclusion
This single center study in real life patients demonstrates that bortezomib combinations used at first line and sequentially at first relapse represent a valid treatment strategy for selected patients.
Session topic: E-poster
Keyword(s): Bortezomib, Myeloma, Relapse, Retreatment
Type: Publication Only
Background
In the United Kingdom (UK), bortezomib (Velcade, Janssen) based triplet regimens are commonly used as first line therapy for both transplant eligible and ineligible patients. The efficacy of re-treatment with bortezomib monotherapy or bortezomib plus dexamethasone in subsequent lines of therapy has been previously reported. However there are limited data on re-treatment at first relapse, particularly with bortezomib-based triplet regimens which are more commonly used in current practice.
Aims
This study aimed to evaluate the efficacy of bortezomib triplet regimens at first relapse in patients previously treated with first line bortezomib. The safety of bortezomib as re-treatment was also assessed.
Methods
This was a retrospective analysis of MM patients at first relapse treated with bortezomib, who had also received bortezomib as first line therapy. Twenty three sequential patients from a single UK center who had achieved at least a partial response (≥PR) and a treatment free interval (TFI) of a minimum of 60 days from first line bortezomib treatment (i.e. not refractory) were identified. Response to treatment and disease progression were defined by the International Myeloma Working Group criteria.
Results
A triplet bortezomib combination was used as first line therapy in 78% of patients (n=18/23) with a median of five cycles given (range 4-8). No patient received maintenance therapy. The median time to best response (TTBR) was 3.5 months (range 0.7-9.0) and the median duration of response (DOR) was 14.9 months (range 4.7-44.5). The overall response rate (ORR) to bortezomib at first relapse was 87% (PR 39%, VGPR 35%, CR 13%). The median TTBR was 4.1 months (range 0.7 -15.0) and median DOR was 11.5 months (range 1.0-18.5). After first line bortezomib, the median time to progression (TTP) was 18.9 months (range 7.3-49.6) whilst it was 14.4 months (range 1.4-16.6) at first relapse. The median TFI was 20.7 months (range 2.0-62.8) after first line bortezomib and 10.4 months (range 1.0-14.0) after bortezomib re-treatment. Ten patients received ASCT at first line compared to 11 at first relapse.Treatment-related toxicity was also evaluated. At first line, eleven patients (48%) experienced peripheral neuropathy (PN) (all grade 1). There were three (13%) grade 3-4 non-hematological adverse events (AE), which were all infections. All but one patient restarted bortezomib at full dose at relapse. Only two patients (11%) required a subsequent dose reduction (for PN). Eleven patients (61%) experienced PN with first relapse treatment (all grade 1-2). There were two grade 3 AEs (diarrhoea and febrile neutropenia). All patients who relapsed for a second time were able to proceed to a third line regimen which was most commonly lenalidomide and dexamethasone.
Conclusion
This single center study in real life patients demonstrates that bortezomib combinations used at first line and sequentially at first relapse represent a valid treatment strategy for selected patients.
Session topic: E-poster
Keyword(s): Bortezomib, Myeloma, Relapse, Retreatment
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