The results of a recent retrospective analysis show that the sequence of treatment with Velcade and Revlimid may not have a significant effect on outcomes in multiple myeloma patients.

Only patients with kidney disease had significantly longer survival times if they received Velcade first.

The researchers from the Moffitt Cancer Center in Tampa, Florida, who conducted the analysis pointed out that further prospective trials are needed to confirm their findings.

The results were presented during a poster session at the 2011 American Society of Hematology (ASH) annual meeting in December.

Velcade ^[1] (bortezomib) and Revlimid ^[2] (lenalidomide) are generally viewed as the most effective drugs for the treatment of multiple myeloma. When patients relapse or do not respond to one, they are often treated with the other.

Although only Velcade is approved by U.S. and European regulatory authorities to treat newly diagnosed myeloma patients, Revlimid is frequently prescribed off-label in the U.S. as a treatment for newly diagnosed myeloma.

The authors of the ASH poster explain, however, that the optimal treatment sequence for the two drugs has not yet been established.

The researchers therefore analyzed data from 208 multiple myeloma patients who had been treated with Velcade followed by Revlimid, or vice versa, at their institution between January 2004 and August 2010. The goal of the analysis was to determine if one treatment sequence was associated with better outcomes than the other.

Of the 208 patients included in the analysis, 47 percent received Revlimid first and 53 percent received Velcade first.

The researchers found that response rates and median overall survival times did not differ significantly by treatment sequence.

The response rate to Velcade in patients who received Velcade first followed by Revlimid was 77 percent.  In patients who first were treated with Revlimid, the response rate when they later were treated with Velcade was 69 percent.

Interestingly, the response rate to Revlimid in patients who were treated with Revlimid first, followed by Velcade, was only 60 percent.  The response rate to Revlimid was noticeably higher -- 74 percent -- when patients were treated with Revlimid after having been treated first with Velcade.

Patients who received Revlimid first had an overall median survival time of 78.5 months, compared to 74 months for patients receiving Velcade first.

The difference in these survival times was not statistically significant.

However, the sequence of therapy did have a significant impact on survival in patients with kidney disease. Patients with kidney disease who received Velcade first had significantly longer median overall survival times (50.0 months) than patients with kidney disease who received Revlimid first (22.5 months).

Other factors, such as disease stage and chromosomal abnormalities, did not significantly affect whether survival was longer with a Revlimid-first or Velcade-first sequence of treatment.

For more information, please see abstract 3979 ^[3] on the ASH 2011 meeting website.