CyBorD delivers comparable efficacy to Vel-Dex in multiple myeloma
In newly diagnosed, transplant-eligible multiple myeloma (MM) patients, induction therapy with cyclophosphamide-bortezomib-dexamethasone (CyBorD) delivers a comparable efficacy to bortezomib-dexamethasone (Vel-Dex), according to a new study presented at the recently concluded 59th American Society of Hematology Annual Meeting (ASH 2017).
Moreover, “[a]dding cyclophosphamide to the chemotherapy regimen did not seem to impair the stem cell collection and was not associated with more grade 3 or 4 toxicities,” researchers said.
The research team performed a retrospective observational study including 84 transplant-eligible adults (median age 56.5 years; 65 percent male) who were newly diagnosed with symptomatic MM, and found that the Vel-Dex and CyBorD resulted in similar response rates both after induction and 100 days after autologous stem cell transplant (ASCT). [ASH 2017, abstract 1870]
In particular, the respective very good partial response or better rates (≥VGPR) for the Vel-Dex (n=44) and CyBorD (n=40) groups after induction were 43.2 and 35.0 percent (p=0.59). The same trend was observed for ≥VGPR at day 100 (56.8 vs 62.5 percent, respectively; p=0.76).
The overall response rates (ORRs) after induction were likewise statistically similar for the Vel-Dex and CyBorD groups (90.9 vs 92.5 percent; p=0.99). ORRs at day 100 were 90.9 and 97.5 percent, respectively (p=0.42).
Of note, except for ≥VGPR after induction, the CyBorD regimen consistently produced numerically better response rates than the Vel-Dex regimen.
Ever since it trumped the vincristine-doxorubicine-dexamethasone regimen, Vel-Dex has been the standard first-line option for induction in MM patients. The current study aimed to perform a direct comparison between CyBorD and Vel-Dex not only in efficacy but also in safety.
Vel-Dex and CyBorD generally produced similar safety profiles, with comparable incidence rates of grade 3 to 4 adverse events such as neutropaenia (0 vs 5 percent; p=0.52), anaemia (4.5 vs 2 percent; p=0.31), thrombocytopaenia (0 vs 2.5 percent; p=0.36), hepatic cytolysis (2.3 vs 2.5 percent; p=0.60) and acute renal failure (0 vs 2.5 percent; p=0.51), among others. No deaths were reported during the study period.
The only adverse event that was significantly different between the treatment groups was peripheral neuropathies, which was significantly more common in the Vel-Dex group (15.9 vs 0 percent; p=0.006).
“[T]here was not any evidence of a significant difference in terms of grade 3 or 4 toxicities, except for sensitive neuropathies that were more prevalent in the Vel-Dex group,” researchers said.
Overall, the findings of the study indicate that based on overall efficacy, there is no conclusive evidence to establish the superiority of CyBorD over Vel-Dex as the induction regimen of choice in transplant-eligible MM patients, researchers said, adding that the nominal advantages of CyBorD need to be proven in more robust and appropriate analyses.
“Longer follow-up is required to detect if what seems to be a more favourable response to post-ASCT with CyBorD leads to differences in progression free survival and overall survival,” they said.