Articles tagged with: Etoposide
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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).
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Entinostat And Treanda Enhance Each Other’s Efficacy Against Myeloma Cells – Results from a recent preclinical study show that Treanda (bendamustine) and the investigational drug entinostat (SNDX-275) enhance each other’s efficacy against multiple myeloma cells. The two drugs, when given together, were more effective than expected based on the efficacy of either drug alone. Entinostat is an oral treatment that belongs to a family of anti-cancer drugs called HDAC inhibitors. Other HDAC inhibitors under investigation for multiple myeloma include Zolinza (vorinostat) and panobinostat. Entinostat is currently being studied in clinical trials for patients with leukemia and breast cancer. A Phase 1 study of Entinostat in myeloma patients and other blood cancer patients was recently completed, but the results have not been published yet. Treanda is approved in the United States as a treatment for chronic lymphocytic leukemia and certain lymphomas, and it is being investigated as a treatment for myeloma. It belongs to a class of drugs known as alkylating agents, which also includes melphalan (Alkeran) and cyclophosphamide (Cytoxan). These drugs damage the DNA of cancer cells, triggering their death. For more information, please refer to the study in Cancer Letters (abstract).
Low Levels Of Adiponectin May Be Associated With A Higher Risk Of Developing Myeloma – Findings from a prospective study show that low levels of the protein adiponectin may be associated with a higher risk of developing multiple myeloma. Adiponectin regulates glucose levels in the blood and is found at lower levels in people who have type-2 diabetes or who are obese. The investigators of the current study compared the levels of different proteins known as adipokines in 174 myeloma patients and 348 healthy individuals. They found that myeloma patients had lower levels of adiponectin than healthy individuals. Based on their findings, the researchers recommend further study of adiponectin as a possible therapeutic target for myeloma. For more information, please see the study in Cancer Epidemiology, Biomarkers, and Prevention (abstract).
Etoposide, Thiotepa, and Melphalan May Be More Effective Than Melphalan Alone – Results from a recent Israeli study show that treatment with etoposide (VP-16), thiotepa, and melphalan may be more effective than melphalan alone prior to stem cell transplantation. In particular, patients who received the three-drug combination had a longer time to progression (44 months versus 17 months) and longer overall survival (not yet reached after a median of 108 months follow-up versus 59 months) than those who received melphalan alone. However, the researchers said that based on the small number of patients included in the study, the three-drug combination appeared to be slightly more toxic than melphalan alone. The investigators still believe that the three-drug combination can be effective in certain myeloma patients receiving a stem cell transplant. Etoposide is a chemotherapy drug used as a treatment for lung and testicular cancer. Previous studies have shown that etoposide is highly effective in mobilizing stem cells. Thiotepa, like melphalan, is an alkylating agent that damages the DNA of cancer cells. For more information, please refer to the study in the journal Leukemia and Lymphoma (abstract).
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Myeloma specialists from the Czech Republic have published clinical trial results that shed further light on chromosomal abnormalities and their impact on survival in newly diagnosed multiple myeloma patients.
Specifically, the researchers found that patients with three or more chromosomal abnormalities, a gain in the 1q21 region, or the translocation t(4;14) have reduced survival compared to patients without such abnormalities.
According to the researchers, their findings highlight the importance of chromosomal abnormalities when considering treatment options for myeloma patients.
They note, however, that their findings need to be confirmed in a prospective, …
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Results of a recent study suggest that etoposide used in combination with G-CSF is a safe and effective mobilization strategy prior to stem cell transplantation in multiple myeloma patients. The combination treatment resulted in a high stem cell harvest after one day of collection in most patients.
Stem cell mobilization is the process of increasing the number hematopoietic (blood forming) stem cells in the circulating blood to ensure that enough are available to be collected for the transplant. Hematopoietic stem cells are primarily found in the bone marrow and circulate in very …