title: Efficacy and safety of reduced-intensity induction therapy with a bortezomib-based regimen in elderly patients with multiple myeloma.
abstract: The therapeutic effects of bortezomib in untreated and refractory/relapsed multiple myeloma have been demonstrated in several clinical trials, displaying superiority to the conventional treatments. However, many treatment-related toxicities, such as bone marrow suppression, infections and peripheral neuropathy, are well known and lead to treatment discontinuation and dose modification, especially in elderly patients. The purpose of this review is to summarize the published literature concerning the efficacy and safety of reduced-intensity induction therapy with bortezomib-based regimens in elderly patients with multiple myeloma. We used the VISTA trial as a reference and compared it with the seven trials identified in a systematic search. The data suggest that low-dose bortezomib significantly reduces therapy-related toxicities, especially neuropathy, and decreases the rate of discontinuation compared with the twice-weekly regimen, without losing efficacy. In light of this review, we suggest that once-weekly infusion of bortezomib in addition to melphalan-prednisone may be considered as a new standard of care in frontline treatment of elderly patients with symptomatic multiple myeloma.
authors.affiliation: S de Hematología, Hospital Universitario 12 de Octubre. Instituto de Investigación 12 de Octubre, Univ Complutense de Madrid, Madrid, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Sopeña
authors.forename: Estela Martín
authors.initials: EM
authors.lastname: Clavero
authors.forename: Paula
authors.initials: P
authors.lastname: Villa
authors.forename: Joaquín
authors.initials: J
authors.lastname: Martínez-López
keywords: bortezomib; elderly patients; multiple myeloma
references.citation: J Clin Oncol. 2010 May 1;28(13):2259-66
references.pmid: 20368561
references.citation: Lancet Oncol. 2010 Oct;11(10):934-41
references.pmid: 20739218
references.citation: N Engl J Med. 2005 Jun 16;352(24):2487-98
references.pmid: 15958804
references.citation: Clin Lymphoma Myeloma Leuk. 2010 Feb;10(1):68-72
references.pmid: 20223732
references.citation: Haematologica. 2010 Feb;95(2):311-9
references.pmid: 20139393
references.citation: Leukemia. 2007 Jan;21(1):30-6
references.pmid: 17096016
references.citation: Cancer. 2008 Aug 15;113(4):765-71
references.pmid: 18543319
references.citation: N Engl J Med. 2003 Jun 26;348(26):2609-17
references.pmid: 12826635
references.citation: Blood. 2010 Dec 2;116(23):4745-53
references.pmid: 20807892
references.citation: Leuk Res. 2011 May;35(5):591-7
references.pmid: 21167601
references.citation: N Engl J Med. 2008 Aug 28;359(9):906-17
references.pmid: 18753647
references.citation: Clin Lymphoma Myeloma. 2006 Sep;7(2):131-4
references.pmid: 17026824
references.citation: Blood. 2010 Apr 22;115(16):3416-7
references.pmid: 20413666