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

Updated: Sep 30, 2019
  • Author: Dhaval Shah, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Bortezomib appears to be of especial benefit in patients with plasma cell leukemia and renal failure. The predominant adverse effects were neuropathy, hypotension, and thrombocytopenia. Despite these results, the exact timing of bortezomib administration in the treatment plan of patients with newly diagnosed multiple myeloma is still evolving through ongoing research.

Varicella-zoster virus reactivation occurs in 10%-60% of patients with MM treated with bortezomib. Antiviral prophylaxis (eg, acyclovir, 400 mg daily) has been found effective for preventing these reactivations. [55]

The FDA approved administration of bortezomib by the subcutaneous (SC) route in January 2012. A study by Moreau et al found that the efficacy of SC bortezomib is not inferior to that of standard IV administration. Moreau also observed a better safety profile with SC administration: in particular, the incidence of grade 2 or greater peripheral neuropathy was 24% for SC compared with 41% for IV; grade 3 or higher peripheral neuropathy occurred in 6% of patients with SC administration vs 16% for IV administration. [55] Starting therapy with SC administration may be considered for patients with pre-existing peripheral neuropathy and those at high risk for it.

A study by Mateos et al found that patients with cytogenetic abnormalities had similar response to bortezomib therapy but shorter survival. The authors concluded that the present treatment schema does not overcome the negative prognosis associated with high-risk cytogenetic abnormalities. [56]

Overall, the data on these novel agents are very encouraging and promising. Nevertheless, oncologists will need further studies to help define the exact timing and role of novel agents in the treatment of MM.


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