Myeloma: VTD Superior to VCD Prior to Intensive Therapy

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Bortezomib plus thalidomide and dexamethasone is preferential to bortezomib with cyclophosphamide and dexamethasone.
Bortezomib plus thalidomide and dexamethasone is preferential to bortezomib with cyclophosphamide and dexamethasone.

Bortezomib plus thalidomide and dexamethasone (VTD) is preferential to bortezomib with cyclophosphamide and dexamethasone (VCD) in preparation of autologous hematopoietic cell transplantation (HCT) for patients with multiple myeloma, a study published in the journal Blood has shown.1

VTD and VCD have both demonstrated high response rates and are 2 of the most commonly used induction regimens prior to autologous HCT; however, there are no head-to-head studies comparing the 2 regimens. Therefore, researchers in France sought to compare VTD with VCD as induction before high-dose therapy and autologous HCT in patients with newly diagnosed multiple myeloma.

For the open-label, phase 3 trial, researchers enrolled 340 patients and randomly assigned them to receive 4 cycles of VTD or VCD.  VTD treatment consisted of four 3-week cycles of bortezomib 1.3 mg/m2 subcutaneously on days 1, 4, 8, and 11, dexamethasone 40 mg on days 1-4, 9-12, and thalidomide 100 mg orally daily. Therapy with VCD was composed of four 3-week cycles of bortezomib, dexamethasone, and cyclophosphamide 500 mg/m2 orally on days 1, 8, and 15.

Results showed that after 4 cycles, 66.3% of patients in the VTD arm achieved a very good partial response vs 56.2% of patients in the VCD group (P = .05). The overall response rate was also significantly higher in the VTD arm, with 92.3% achieving a response compared with 83.4% in the VCD arm (P = .01).

In terms of safety, researchers found that hematologic toxicity was more common in the VCD arm. Rates of grade 3 to 4 anemia, thrombocytopenia, and neutropenia were significantly higher in the VCD arm than the VTD arm.

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However, peripheral neuropathy was more frequently reported with VTD treatment. There were no other significant differences with regard to treatment-related adverse events between the VTD and VCD groups.

Reference

  1. Moreau P, Hulin C, Macro M, et al. VTD is superior to VCD prior to intensive therapy in multiple myeloma: results of the prospective IFM2013-04 trial [published online ahead of print March 21, 2016]. Blood. doi: 10.1182/blood-2016-01-693580.

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