Findings from a recent retrospective study conducted in Korea indicate that a combination of dex­a­meth­a­sone, cyclo­phos­phamide, etoposide, and cisplatin may be a suitable bridging therapy for relapsed multiple myeloma patients who previously received treatment with novel agents.

Most patients responded to the combination as salvage therapy or achieved stable disease, but the response rates were not durable.  Therefore, the researchers suggested that the combination might serve better as bridging therapy - to stabilize the myeloma until the patients receive further treatment, such as stem cell transplantation or access to investigational therapies in clinical trials.

These results are particularly relevant for multiple myeloma patients in countries where access to novel agents, such as thalidomide (Thalomid), Velcade (bortezomib), and Revlimid (lenalidomide), is restricted, and also patients for whom novel agents no longer work.

The retrospective analysis was based on data from 59 patients who received dexa­metha­sone (Decadron), cyclo­phos­pha­mide (Cytoxan), etoposide (VP-16), and cisplatin, commonly referred to as DCEP, as salvage therapy between 2006 and 2013. The median patient age was 58 years, and patients had received a median of three prior therapies, including at least one novel agent such as thalidomide, Revlimid, or Velcade.

Overall, 45 percent of patients responded to the treatment, with 2 percent achieving a complete response, 2 percent a very good partial response, and 41 percent a partial response. An additional 16 percent of patients achieved a minor response and 20 percent had stable disease.

The median progression-free survival was 3.7 months and the median overall survival was 8 months, which according to the researchers indicate that a durable response is hard to achieve with this regimen. Based on these findings, the researchers conclude that DCEP may be more suitable as a bridging therapy by stabilizing the disease for the next treatment.

The most common severe side effects were blood-related and included low white blood cell counts (92 percent), low platelet counts (76 percent), and low red blood cell counts (71 percent).  Overall, 62 percent of patients discontinued treatment due to side effects.

The treatment-related death rate was notable at 15 percent.  Nearly all of the treatment-related deaths were due to infection in patients with low white blood cell counts.  

The researchers therefore recommend that patients being treated with DCEP also receive growth factors to increase blood cell counts and reduce the chance of infection.

For more information, please refer to the study in the Annals of Hematology (abstract).