Michele Cavo et al. Bortezomib (Velcade)-thalidomide-dexamethasone (VTD) vs thalidomide-dexamethasone (TD) in preparation for autologous stem-cell (SC) transplantation (ASCT) in newly diagnosed multiple myeloma (MM). Proc ASH 2007. Abstract 73

FACULTY COMMENTS

DR RICHARDSON: The GIMEMA trial compared induction with bortezomib/thalidomide /dexamethasone — the so-called VTD regimen — to thalidomide/dexamethasone (TD) in preparation for autologous transplantation. Impressive responses to primary therapy were seen, including a 36 percent nCR*/CR rate for VTD, versus nine percent for thal/dex, and a doubling in the number of patients achieving VGPR† or better with the addition of bortezomib to the thal/dex.

What was particularly interesting in my view was that although TD had a six percent rate of progressive disease, which is low, this was zero for VTD, suggesting that the combination of the three drugs was active in all the patients treated.

An important point observed in this trial was that bortezomibbased therapy was effective regardless of chromosome 13 deletion or other adverse risk features, including high ß₂-microglobulin and 4;14 translocation.

Whilst it’s fair to say that we have been very pleased with the impact of bortezomib in the relapsed/refractory setting, the magnitude of impact in the up-front setting has now been found to be dramatic. Thalidomide/dexamethasone has been a very important up-front combination. This study shows that when bortezomib is added to this combination, the quality and depth of responses are significantly improved, which is likely to translate into clinical benefit, although long-term follow-up data are of course needed and are awaited with interest.

DR JAKUBOWIAK: VTD was superior across the board compared to TD, and transplant did not nullify this difference, which means that it is important to initiate therapy with a superior regimen. At the end of transplant, you may have a higher percentage of patients achieving VGPR or CR, and the presumption is that this will eventually translate into a longer progression-free and overall survival.

* nCR = near complete response (CR, except immunofixation-positive)
† VGPR = very good partial response