Phase II trial of combination therapy with bortezomib, pegylated liposomal doxorubicin, and dexamethasone in patients with newly diagnosed myeloma

Andrzej J. Jakubowiak, Tara Kendall, Ammar Al-Zoubi, Yasser Khaled, Shin Mineishi, Asra Ahmed, Erica Campagnaro, Christine Brozo, Thomas Braun, Moshe Talpaz, Mark S. Kaminski

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Abstract

Purpose: This single-center, open-label, phase II trial evaluated the bortezomib, pegylated liposomal doxorubicin (PLD), and dexamethasone combination regimen (VDD) as initial treatment for patients with newly diagnosed multiple myeloma (MM). Patients and Methods: Enrolled patients (N = 40) received up to six 3-week cycles of treatment with bortezomib 1.3 mg/m2 intravenously (IV) on days 1, 4, 8, and 11; PLD 30 mg/m2 IV on day 4; and dexamethasone 20 to 40 mg daily as specified in the study design. The primary end point was the complete/nearcomplete response (CR/nCR) rate after six cycles. Secondary end points included overall response rate (ORR), progression-free survival (PFS), and overall survival (OS). The impact of VDD on stem-cell mobilization and collection also was evaluated. Results: After six cycles, the ORR was 85.0% (CR/nCR, 37.5%; very good partial response [VGPR] or better, 57.5%). Patients who underwent stem-cell transplantation (SCT) after VDD (n = 30) experienced increased rates of VGPR or better (53.3% to 76.6% after SCT). Overall, 1-year PFS and OS rates were 92.5% and 97.5%, respectively. Those who achieved VGPR or better after treatment with VDD showed a significantly greater 1-year PFS versus those who achieved less than VGPR (100% v 82%, respectively; P = .03). Similar results were observed in patients who underwent SCT. Grades 3 or 4 hematologic toxicities occurred in ≤ 10% of patients; grade 2 painful neuropathy occurred in 7.5%; and grade 3 palmar-plantar erythrodysesthesia occurred in 2.5%. Conclusion: VDD is highly effective for initial treatment of MM followed by SCT in appropriate patients, and it has a reasonable safety profile. Achievement of VGPR or better with this initial therapy predicted longer PFS, regardless of the consolidation therapy given.

Original languageEnglish (US)
Pages (from-to)5015-5022
Number of pages8
JournalJournal of Clinical Oncology
Volume27
Issue number30
DOIs
StatePublished - Oct 20 2009

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

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    Jakubowiak, A. J., Kendall, T., Al-Zoubi, A., Khaled, Y., Mineishi, S., Ahmed, A., Campagnaro, E., Brozo, C., Braun, T., Talpaz, M., & Kaminski, M. S. (2009). Phase II trial of combination therapy with bortezomib, pegylated liposomal doxorubicin, and dexamethasone in patients with newly diagnosed myeloma. Journal of Clinical Oncology, 27(30), 5015-5022. https://doi.org/10.1200/JCO.2008.19.5370