What is the role of bortezomib for the treatment of multiple myeloma (MM)?

Updated: May 11, 2021
  • Author: Dhaval Shah, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Bortezomib (Velcade), a proteosome inhibitor, has shown striking activity against MM. Objective responses as high as 27.7% in patients with relapsed and heavily pretreated MM [57] led to its approval by the FDA in 2003. Subsequent studies reported response rates as high as 80% when bortezomib is combined with melphalan.

A randomized trial that compared bortezomib plus dexamethasone with VAD for induction showed response rates of 80% for the bortezomib plus dexamethasone arm versus 62.8% for the VAD arm. [58] This regimen has been shown to be active not only before but also after transplantation. Following high-dose therapy and autologous transplantation, the rate of very good partial response or better continued to favor bortezomib plus dexamethasone. This benefit was observed independent of beta-2 microglobulin or adverse cytogenetic risk groups.

Similarly, a superior response rate was seen when the combination of bortezomib, thalidomide, and dexamethasone (VTd) was compared with thalidomide plus dexamethasone in a large phase III study: 93% in the VTd arm versus 80% in the thalidomide-dexamethasone arm, in which patients went on to receive tandem autologous stem cell transplantation. [59] As in other studies, response was independent of adverse prognostic risk factors.

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