FACULTY COMMENTS
DR JAKUBOWIAK: Bortezomib combined with doxorubicin and dexamethasone (PAD) is an extremely active regimen, with overall and complete response rates that are almost identical to VdoxD in indirect comparison. It is a tolerable regimen and can be used pretransplant with rapid and effective cytoreduction and no impact on collection of stem cells. The flip side of PAD is a reasonably high rate of peripheral neuropathy, especially in the arm with the higher dose of bortezomib.
I consider PAD (or VdoxD), RVD and VDT to be the top three-drug regimens for initial cytoreduction of patients who have disease requiring rapid cytoreduction and who are potential candidates for transplant.
DR ORLOWSKI: I’m a big fan of anthracyclines, so I certainly like the combination. The concerns are the relatively high rate of neurotoxicity that was seen with the 1.3-mg/m2 dose, although with the 1.0-mg/m2 dose the neuropathy was much lower.
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