Bortezomib for maintenance, consolidation ups survival in multiple myeloma
Bortezomib-based consolidation and maintenance therapies for multiple myeloma improve survival but come with safety concerns, reports a recent meta-analysis.
Accessing the databases of Embase, Web of Science and PubMed, researchers retrieved ten randomized controlled trials (n=3,147), in which bortezomib-containing regimens were compared to other treatments or to observation. Outcomes included progression-free (PFS) and overall (OS) survival, as well as the occurrence of adverse events.
Bortezomib-based maintenance therapies showed significant efficacy in boosting PFS (hazard ratio [HR], 0.72, 95 percent confidence interval [CI], 0.55–0.95; p=0.02) and OS (HR, 0.71, 95 percent CI, 0.58–0.87; p=0.001). Excluding transplant-ineligible patients attenuated the effect on PFS, but only slightly (HR, 0.94, 95 percent CI, 0.699–1.001; p=0.052). The benefit on OS remained significant (HR, 0.72, 95 percent CI, 0.54–0.96; p=0.025).
In comparison, bortezomib-based consolidation therapies improved only PFS (HR, 0.77, 95 percent CI, 0.68–0.88; p<0.001) but not OS (HR, 0.98, 95 percent CI, 0.78–1.24; p=0.87). Excluding one study did not change this.
In terms of safety, researchers also found that bortezomib-containing consolidation and maintenance therapies came with a higher risk of grade ≥3 neurologic symptoms that was of borderline significance (risk ratio [RR], 1.59, 95 percent CI, 0.94–2.69; p=0.08).
There were also nonsignificant increases in the likelihood of developing gastrointestinal symptoms (RR, 1.66, 95 percent CI, 0.71–3.88; p=0.24) and fatigue (RR, 2.10, 95 percent CI, 0.83–5.30; p=0.12).