Continuous treatment with Velcade (bortezomib), doxorubicin (Adriamycin), and dexamethasone (Decadron) (VDD), followed by thalidomide (Thalomid) and dexamethasone (TD), is a safe and effective salvage therapy for patients with relapsed/refractory multiple myeloma, according to a study recently published in the journal Annals of Hematology.

The treatment of myeloma patients who have relapsed or who are resistant (refractory) to treatment remains a challenge for doctors. In these cases, doctors must implement a “plan B” method of treatment, which is commonly known as salvage therapy; however, the choice of which salvage therapy to prescribe depends on many factors, including the patient’s age and previous treatments.

In this study, researchers examined the effectiveness and tolerability of VDD, followed by TD therapy, as a salvage therapy in 40 relapsed/refractory myeloma patients.

In order to be eligible for the clinical trial, patients could not have been previously treated with Velcade, could not be resistant to thalidomide, and could not have significant prior exposure to doxorubicin.

Patients received six 21-day cycles of Velcade (1.3 mg/m² on days 1, 4, 8, and 11), doxorubicin (4.5 mg/m² on days 1 to 4), and dexamethasone (40 mg on days 1 to 4). After receiving six cycles of VDD, patients who responded to treatment received 12 28-day cycles of thalidomide (100 mg daily) and dexamethasone (40 mg on days 1 to 4). Patients who experienced disease progression received higher doses (200 mg) of thalidomide during TD therapy.  Doctors followed up with patients for a median of 27 months.

The overall response rate was 83.6 percent, with 51.4 percent of patients achieving complete response, 13.4 percent near-complete response, 5.4 percent very good partial response, and 13.4 percent partial response.

The median progression-free survival was 18 months, with 25.7 percent of patients achieving three or more years of progression-free survival. The median overall survival was 35.1 months.

The most common side effects associated with VDD included low platelet count (61.5 percent), low red blood cell count (46.2 percent), and low white blood cell count (7.7 percent). Twenty percent of patients experienced low white blood cell counts during TD treatment.

Although no studies have examined the optimal sequences for administering chemotherapy drugs in salvage therapies, researchers concluded that it is beneficial to use more active drugs, such as Velcade, early in treatment. The researchers noted that patients who had only one prior therapy experienced longer overall survivals and higher response rates than patients who had more than one prior therapy.

Although the researchers could not determine the optimal duration of VDD treatment and TD therapy, they concluded that the sequential combination of VDD followed by TD is a highly active and well-tolerated salvage treatment for relapsed and refractory myeloma.

For more information, please read the original article in the journal Annals of Hematology (abstract).