Cisplatin (10 mg/sqm/d) d1-4 continuous infusion Doxorubicin (10 mg/sqm/d) d1-4 continuous infusion Cyclophosphamide (400 mg/sqm/d) d1-4 continuous infusion Etoposide (40 mg/sqm/d) d1-4 continuous infusion Bortezomib IV 1.0 mg/sqm (d 1,4,8,11) Thalidomide 100 mf daily PO
A total of 4 cycles of VDT-PACE were administered every 4-6 weeks
Gabriele Buda et al VDTPACE As Salvage Therapy For Heavily Pretreated MM Patients November 15, 2013; Blood: 122 (21)
Overall response rate was 63% (very-good partial response 7%, partial response 56%) with stable disease in an additional 12% of patients. Median progression-free survival (PFS) was 7 months (95% confdence interval [CI]:4.0 - 9.9). VDTPACE is an intensive regimen which was given in our cohort on an inpatient basis because myelotoxicity is common. The rates of grade 3-4 neutropenia (56%) and febrile neutropenia (56%) were high although GCSF support was used routinely as prophylaxis. The most common non-haematological toxicities were grade 1-2 metabolic abnormalities that were easily corrected. VDTPACE is an effective salvage therapy for heavily pretreated MM patients. In the era of new targeted, biologically active agents against MM, there are now many more options for refractory and relapsed disease. Unfortunately, many of these newer agents are costly and awaiting approval in a number of countries. Consequently, alternative therapies are needed. Although the overall response rate of 63% in this poor prognosis cohort is more than promising, the PFS is short, suggesting the best role for VDTPACE is in bridging to defnitive therapy, such as allo-transplantation.