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Evidence summaries

Bortezomib for the Treatment of Multiple Myeloma

Myeloma patients receiving bortezomib benefit in terms of overall survival (OS), progression-free survival (PFS) and response rate compared to those who do not receive bortezomib. This benefit is observed in trials of bortezomib versus no bortezomib with the same or different background therapy. Level of evidence: "A"

Summary

A Cochrane review [Abstract] 1 included 16 studies with a total of 5626 subjects. All trials were randomised and open-label studies.

Bortezomib prolongs overall survival (OS) (four studies, 1586 patients; Peto OR 0.77, 95% CI 0.65 to 0.92) and progression free survival (PFS) (five studies, 1855 patients; Peto OR 0.65, 95% CI 0.57 to 0.74) from analysing trials of bortezomib versus no bortezomib with the same background therapy in each arm.

Bortezomib prolongs OS (five studies, 2532 patients; Peto OR 0.76, 95% CI 0.67 to 0.88) and PFS (four studies, 2489 patients; Peto OR 0.67, 95% CI 0.61 to 0.75) from analysing trials of bortezomib versus no bortezomib with different background therapy in each arm or compared to other agent(s).Four trials (N = 716) examined different doses, methods of administrations and treatment schedules and were reviewed qualitatively only.

Patients treated with bortezomib have increased risk of thrombocytopenia, neutropenia, gastro-intestinal toxicities, peripheral neuropathy, infection and fatigue. There is high-quality evidence for increased risk of cardiac disorders from analysing trials of bortezomib versus no bortezomib with different background therapy in each arm or versus other agents. The risk of treatment-related death (TRD) in either comparison group analysed is uncertain.Only four trials analysed health related quality of life (HRQoL) and the data could not be meta-analysed.Subgroup analyses by disease setting revealed improvements in all outcomes, whereas for therapy setting, an improved benefit for bortezomib was observed in all outcomes and subgroups except for OS following consolidation therapy.

Clinical comments

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    References

    • Scott K, Hayden PJ, Will A et al. Bortezomib for the treatment of multiple myeloma. Cochrane Database Syst Rev 2016;(4):CD010816. [PubMed]

Primary/Secondary Keywords