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Clin Lymphoma Myeloma Leuk. 2014 Oct;14(5):380-8. doi: 10.1016/j.clml.2014.03.005. Epub 2014 Jun 11.

Meta-analysis of the efficacy and safety of bortezomib re-treatment in patients with multiple myeloma.

Author information

1
California Pacific Medical Center, Sutter Health, San Francisco, CA. Electronic address: leroy@alum.MIT.edu.
2
Analysis Group, Inc, Boston, MA.
3
Groupe d'analyse, Ltée, Montreal, Quebec, Canada.
4
Millennium: The Takeda Oncology Company, Cambridge, MA.
5
Department of Hematology/Oncology, Tufts Medical Center, Boston, MA.

Abstract

INTRODUCTION:

Bortezomib is administered for a finite course; thus, patients might remain sensitive to bortezomib-based therapy at relapse. We report a meta-analysis of bortezomib-based retreatment in relapsed/refractory myeloma.

PATIENTS AND METHODS:

A systematic literature review identified studies of bortezomib-based retreatment in relapsed/refractory myeloma. Proportions of bortezomib-refractory patients and additional prognostic factors were extracted and used in weighted stratified analyses of TTP and OS. Random-effect pooled estimates were calculated for overall response rate (ORR) and rates of common AEs.

RESULTS:

Twenty-three studies (n = 1051 patients) were identified. Bortezomib was administered intravenously in all studies. Across studies in which data were available, pooled, weighted average ORR was 39.1% (95% confidence interval, 30.8%-47.4%), and pooled, weighted average median TTP and OS were 7.5 and 16.6 months, respectively. Patients with fewer previous therapies (≤ 4) and relapsed (not refractory) patients achieved higher ORRs, of 43.4% and 57.2%, respectively. Random-effects meta-regression analysis confirmed that relapsed patients were associated with a higher ORR by 28 to 41 percentage points versus refractory patients. In relapsed patients, median TTP and OS were 8.5 and 19.7 months, respectively. Common Grade 3/4 AEs included thrombocytopenia (35%), neutropenia (15%), anemia (14%), pneumonia (10%), and peripheral neuropathy (3%).

CONCLUSION:

Based on these findings, bortezomib retreatment is well tolerated and appears efficacious in relapsed patients. In an era of new and emerging treatment options for relapsed and/or refractory myeloma, these data indicate that bortezomib retreatment might be a highly effective option in previously treated patients.

KEYWORDS:

Meta-regression analysis; Overall response rate; Random-effect model; Refractory; Relapsed

PMID:
25023616
DOI:
10.1016/j.clml.2014.03.005
[Indexed for MEDLINE]

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