Bortezomib and lenalidomide as front-line therapy for multiple myeloma.
Author(s): Zou Y(1), Lin M, Sheng Z, Niu S.
Affiliation(s): Author information:
(1)Internal Medicine, GuangDong Women and Children Hospital , GuangZhou , China.
Publication date & source: 2014, Leuk Lymphoma. , 55(9):2024-31
The objective of the study was to investigate the effects and safety of novel
agents such as bortezomib and lenalidomide in the treatment of newly diagnosed
patients with multiple myeloma. We performed a comprehensive meta-analysis of
randomized controlled trials (RCTs). An initial search yielded 627 citations, of
which 10 RCTs enrolling 4534 patients met the inclusion criteria. The addition of
bortezomib to first-line therapy significantly prolonged overall survival (OS)
(hazard ratio [HR], 0.75 [0.65, 0.87], p < 0.001). On the other hand, the
addition of lenalidomide had no impact on survival (HR, 0.88 [0.65, 1.20], p =
0.42). Both lenalidomide and bortezomib consistently improved progression-free
survival (PFS) compared with conventional therapy alone. The corresponding HRs
were 0.65, 95% confidence interval (CI) [0.55, 0.77] (p < 0.001) for bortezomib
and 0.48, 95% CI [0.42, 0.55]; (p < 0.001) for lenalidomide, respectively. Some
of the increased adverse events reported were herpes zoster (relative risk [RR],
3.64 [2.23, 5.94], p < 0.001), peripheral neuropathy (RR, 3.59 [1.89, 6.83], p <
0.001) and gastrointestinal effects (RR, 2.19 [1.37, 3.50], p = 0.001) among
patients receiving bortezomib, and gastrointestinal effects (RR, 2.36 [1.33,
4.17], p = 0.003) and thromboembolic events (RR, 2.55 [1.48, 4.38], p < 0.001)
among patients receiving lenalidomide. Interestingly, treatment with bortezomib
seemed to be associated with a lower rate of treatment related mortality (RR,
0.39 [0.18, 0.85], p = 0.02). An increased incidence of second primary cancers
was observed in the lenalidomide group (RR 2.61 [1.60, 4.27], p < 0.001). In
summary, bortezomib improved OS, and both lenalidomide and bortezomib
consistently improved PFS of patients with newly diagnosed myeloma when it was
added to standard therapy.
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