title: Bortezomib-thalidomide-based regimens improved clinical outcomes without increasing toxicity as induction treatment for untreated multiple myeloma: a meta-analysis of phase III randomized controlled trials.
abstract: Novel agents thalidomide and bortezomib have significantly improved myeloma treatment. However, it remains unclear whether patients will benefit more from the combination therapy of these two agents. Our meta-analysis aims to compare the efficiency, and more importantly, the safety of bortezomib-thalidomide-based (VT-based) versus bortezomib-based or thalidomide-based (V-based/T-based) regimens as induction therapy in patients with previously untreated myeloma. Overall, five phase III RCTs including 1765 patients were identified. Compared with V-based or T-based regimens, VT-based regimens significantly improved CR (OR=2.22, 95% CI [1.44, 3.43]), ORR (OR=2.19, 95% CI [1.51, 3.19]) as well as PFS (HR=0.69, 95% CI [0.54, 0.88]), but not OS (HR=1.04, 95% CI [0.91, 1.19]). Notably, most expected side effects of bortezomib or thalidomide were comparable in both groups, including hematologic (anemia, neutropenia, thrombocytopenia), nonhematologic (peripheral neuropathy, deep venous thrombosis, infections, gastrointestinal events) side effects and discontinuation during or after induction therapy. These results suggest that combination of thalidomide and bortezomib might be a better first-line choice for patients with untreated myeloma.
authors: The Myeloma and Lymphoma Center, Department of Hematology, Changzheng Hospital, Shanghai, China.
authors: Hejing
authors: H
authors: Huang
authors: The Myeloma and Lymphoma Center, Department of Hematology, Changzheng Hospital, Shanghai, China.
authors: Lili
authors: L
authors: Zhou
authors: The Myeloma and Lymphoma Center, Department of Hematology, Changzheng Hospital, Shanghai, China.
authors: Lihui
authors: L
authors: Peng
authors: The Myeloma and Lymphoma Center, Department of Hematology, Changzheng Hospital, Shanghai, China.
authors: Weijun
authors: W
authors: Fu
authors: The Myeloma and Lymphoma Center, Department of Hematology, Changzheng Hospital, Shanghai, China.
authors: Chunyang
authors: C
authors: Zhang
authors: The Myeloma and Lymphoma Center, Department of Hematology, Changzheng Hospital, Shanghai, China. Electronic address: houjian@medmail.com.cn.
authors: Jian
authors: J
authors: Hou
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001897:Boronic Acids / Q000008:administration & dosage* / Q000009:adverse effects*; D000069286:Bortezomib; D017326:Clinical Trials, Phase III as Topic / Q000706:statistics & numerical data; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology; D006801:Humans; D060828:Induction Chemotherapy / Q000009:adverse effects / Q000379:methods*; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000401:mortality; D020360:Neoadjuvant Therapy; D009503:Neutropenia / Q000139:chemically induced / Q000453:epidemiology; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced / Q000453:epidemiology; D011719:Pyrazines / Q000008:administration & dosage* / Q000009:adverse effects*; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D016019:Survival Analysis; D013792:Thalidomide / Q000008:administration & dosage* / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D001897:Boronic Acids; D011719:Pyrazines; D013792:Thalidomide; D000069286:Bortezomib
keywords: Bortezomib; Meta-analysis; Multiple myeloma; Randomized controlled trials; Thalidomide