Affiliation:
1. From the Dana-Farber Cancer Institute; Beth Israel Deaconess Medical Center; Massachusetts General Hospital; Millennium Pharmaceuticals; Brigham and Women's Hospital, Boston, MA; Roswell Park Cancer Institute, Buffalo; Memorial Sloan-Kettering Cancer Center, New York, NY; Winship Cancer Institute, Emory University, Atlanta, GA; and University of British Columbia, Vancouver, British Columbia, Canada.
Abstract
PurposeTo assess efficacy and safety of single-agent bortezomib in previously untreated patients with multiple myeloma, investigate prevalence of baseline and treatment-emergent polyneuropathy, and identify molecular markers associated with response and neuropathy.Patients and MethodsPatients received bortezomib 1.3 mg/m2on days 1, 4, 8, and 11, for up to eight 21-day cycles. A subset of patients underwent neurophysiologic evaluation pre- and post-treatment. Bone marrow aspirates were performed at baseline for exploratory whole-genome analyses.ResultsAmong 64 patients, 41% had partial response or better, including 9% complete/near-complete responses; median duration of response was 8.4 months. Response rates did not differ in the presence or absence of adverse cytogenetics. After median follow-up of 29 months, median time to progression was 17.3 months. Median overall survival had not been reached; estimated 1-year survival was 92%. Thirty-two patients successfully underwent optional stem-cell transplantation. Bortezomib treatment was generally well tolerated. At baseline, 20% of patients had sensory polyneuropathy. Sensory polyneuropathy developed during treatment in 64% of patients (grade 3 in 3%), but proved manageable and resolved in 85% within a median of 98 days. Neurologic examination, neurophysiologic testing, and measurements of epidermal nerve fiber densities in 35 patients confirmed pretreatment sensory neuropathy in 20% and new or worsening neuropathy in 63%. Pharmacogenomic analyses identified molecular markers of response and treatment-emergent neuropathy, which will require future study.ConclusionSingle-agent bortezomib is effective in previously untreated myeloma. Baseline myeloma-associated neuropathy seems more common than previously reported, and bortezomib-associated neuropathy, although a common toxicity, is reversible in most patients.
Publisher
American Society of Clinical Oncology (ASCO)
Cited by
241 articles.
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