In addition to Velcade’s anti-myeloma effects, Velcade may also enhance bone formation, according to a Korean study of two multiple myeloma patients.

Based on the findings, the study investigators suggested that Velcade ^[1] (bortezomib) treatment may be beneficial in patients with destructive bone disease.

However, in correspondence with the Myeloma Beacon, Dr. Chang-Ki Min, lead author of the study noted, “I believe that the incidental findings require additional studies. For example, clinical results such as response to Velcade or skeletal-related events [in this patient population] should be investigated.”

Dr. Kristy Weber, professor of orthopedics and oncology at the Johns Hopkins School of Medicine also cautioned that no serious conclusions could be drawn from such a small study.

Bone disease is a major complication associated with multiple myeloma. It is the result of two simultaneous events: an increase in activity of cells that degrade bone and also a decrease in activity of cells that form bone.

Many myeloma patients receive bisphosphonates as treatment for bone disease while undergoing anti-myeloma therapy. Bisphosphonates prevent further degradation of the bone. They do not, however, help reform lost bone mass.

Recent studies in mice have demonstrated that Velcade enhances the function of bone-forming cells. Furthermore, bone formation markers in the blood have been shown to increase in myeloma patients treated with Velcade.

The goal of this study was to determine the effect of Velcade on bone lesions resulting from multiple myeloma.

The study was comprised of two myeloma patients, both 61 year old males with bone disease in their spines.

The patients had varying treatment histories. The first was treated with vincristine ^[2] (Oncovin), doxorubicin ^[3] (Adriamycin), and dexamethasone ^[4] (Decadron) prior to autologous stem cell transplantation. He achieved a very good partial response and maintained therapy with interferon and prednisone ^[5], but relapsed 18 months later. At this point, he developed additional bone lesions, was switched to Velcade therapy, and was monitored for bone formation.

The second patient was initially treated with Velcade, doxorubicin, and dexamethasone and achieved complete response after three cycles of therapy. He was monitored for bone formation prior to receiving an autologous stem cell transplant and maintenance therapy with thalidomide ^[6] (Thalomid) and dexamethasone.

Bone scans were performed on both patients to determine the effect of Velcade on their lesions. After three cycles of Velcade treatment, both patients showed increased bone formation at the site of their lesions.

When asked if bisphosphonate treatment in addition to Velcade may reverse bone degradation, Dr. Min noted that some patients have shown reversal of bone lesions after Velcade and bisphosphonate treatment. However, Dr. Min has not performed any studies to confirm this observation.

For more information, see the study in the European Journal of Haematology ^[7] (abstract).