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- Title
Single-agent bortezomib in previously untreated multiple myeloma: efficacy, characterization of peripheral neuropathy, and molecular correlations with response and neuropathy.
- Authors
Richardson, Paul G; Xie, Wanling; Mitsiades, Constantine; Chanan-Khan, Asher A; Lonial, Sagar; Hassoun, Hani; Avigan, David E; Oaklander, Anne Louise; Kuter, David J; Wen, Patrick Y; Kesari, Santosh; Briemberg, Hannah R; Schlossman, Robert L; Munshi, Nikhil C; Heffner, L Thompson; Doss, Deborah; Esseltine, Dixie-Lee; Weller, Edie; Anderson, Kenneth C; Amato, Anthony A
- Abstract
PURPOSE To assess efficacy and safety of single-agent bortezomib in previously untreated patients with multiple myeloma, investigate prevalence of baseline and treatment-emergent polyneuropathy, and identify molecular markers associated with response and neuropathy. PATIENTS AND METHODS Patients received bortezomib 1.3 mg/m(2) on days 1, 4, 8, and 11, for up to eight 21-day cycles. A subset of patients underwent neurophysiologic evaluation pre- and post-treatment. Bone marrow aspirates were performed at baseline for exploratory whole-genome analyses. Results Among 64 patients, 41% had partial response or better, including 9% complete/near-complete responses; median duration of response was 8.4 months. Response rates did not differ in the presence or absence of adverse cytogenetics. After median follow-up of 29 months, median time to progression was 17.3 months. Median overall survival had not been reached; estimated 1-year survival was 92%. Thirty-two patients successfully underwent optional stem-cell transplantation. Bortezomib treatment was generally well tolerated. At baseline, 20% of patients had sensory polyneuropathy. Sensory polyneuropathy developed during treatment in 64% of patients (grade 3 in 3%), but proved manageable and resolved in 85% within a median of 98 days. Neurologic examination, neurophysiologic testing, and measurements of epidermal nerve fiber densities in 35 patients confirmed pretreatment sensory neuropathy in 20% and new or worsening neuropathy in 63%. Pharmacogenomic analyses identified molecular markers of response and treatment-emergent neuropathy, which will require future study. CONCLUSION Single-agent bortezomib is effective in previously untreated myeloma. Baseline myeloma-associated neuropathy seems more common than previously reported, and bortezomib-associated neuropathy, although a common toxicity, is reversible in most patients.
- Publication
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2009, Vol 27, Issue 21, p3518
- ISSN
1527-7755
- Publication type
Journal Article
- DOI
10.1200/JCO.2008.18.3087