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.
- 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.