FACULTY COMMENTS
DR RICHARDSON: The IFM 2005/01 trial is another landmark
study with an innovative design comparing bortezomib and
dexamethasone versus the standard approach of VAD as an
induction treatment prior to at least one transplant.
It examined the role of consolidation chemotherapy as a part of induction and evaluated the need for tandem transplants based on the quality of response to each induction approach.
The results of response to induction were presented at the recent ASH 2007 meeting and showed a pretransplant VGPR or better of 47 percent with bortezomib and dexamethasone, versus 19 percent with VAD.
A key message from this trial is that the depth and quality of response were not only better pretransplant but also continued post-transplant.
Importantly, this randomized trial suggested that consolidation chemotherapy with DCEP did not convey benefit.
In aggregate, the data suggest that bortezomib-based therapy pretransplant should be considered a new standard, because it is generally believed that the quality of response pretransplant matters, and bortezomib-based therapy also appears to enhance the quality of response post-transplant.
DR JAKUBOWIAK: The study demonstrated superior response
rates for bortezomib and dexamethasone compared to VAD,
regardless of whether the patient had poor-risk cytogenetics
and that superiority was maintained when patients subsequently
underwent transplant.
Harousseau and colleagues designed this study so that patients who achieved a VGPR after first transplant did not need to receive a second transplant. So, fewer patients treated with bortezomib and dexamethasone needed to undergo a second transplant. This could save lives because there is a five percent mortality rate with any single transplant.
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