Multiple myeloma treatment strategies with novel agents in 2011: a European perspective

Abstract

The arrival of the novel agents thalidomide, bortezomib, and lenalidomide has significantly changed our approach to the management of multiple myeloma and, importantly, patient outcomes have improved. These agents have been investigated intensively in different treatment settings, providing us with data to make evidence-based decisions regarding the optimal management of patients. This review is an update to a previous summary of European treatment practices that examines new data that have been published or presented at congresses up to the end of 2010 and assesses their impact on treatment practices.

Figure 1.

Multiple myeloma treatment tree outside clinical trials: frontline. ^aIndicates data available from phase III randomized trial. Lenalidomide is currently not EMA approved for the treatment of newly diagnosed multiple myeloma or as consolidation or maintenance treatment. Bortezomib is currently not EMA approved for the treatment of transplant-eligible patients or as consolidation or maintenance treatment. Thalidomide is currently not EMA approved for the treatment of transplant eligible patients or as consolidation or maintenance treatment. Abbreviations: CR, complete response; CTD, cyclophosphamide, thalidomide, and dexamethasone; CTDa, attenuated cyclophosphamide, thalidomide, and dexamethasone; MP, melphalan and prednisone; MPR + R, melphalan, prednisone, and lenalidomide plus lenalidomide maintenance; MPT, melphalan, prednisone, and thalidomide; PAD, bortezomib, doxorubicin, and dexamethasone; PN, peripheral neuropathy; Pred, prednisone; Rd, lenalidomide plus low-dose dexamethasone; RD, lenalidomide and dexamethasone; TAD, thalidomide, doxorubicin, and dexamethasone; Thal, thalidomide; TT3, Total Therapy 3; VCD, bortezomib, cyclophosphamide, and dexamethasone; VDT-PACE, bortezomib, dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophosphamide, and etoposide; VGPR, very good partial response; VMP, bortezomib, melphalan, and prednisone; VMPT-VT, bortezomib, melphalan, prednisone,and thalidomide followed by maintenance with bortezomib and thalidomide; VRD, bortezomib, lenalidomide, and dexamethasone; VTD, bortezomib, thalidomide, and dexamethasone.

Figure 2.

Multiple myeloma treatment tree outside clinical trials: relapse. ^aIndicates data available from phase III randomized trial. ^bRetreatment with bortezomib after frontline bortezomib only if no PN is present, or if PN has recovered and there is no other therapeutic alternative. Abbreviations: ASCT, autologous stem cell transplantation; CRD, cyclophosphamide, lenalidomide, and dexamethasone; CTD, cyclophosphamide, thalidomide, and dexamethasone; Dex, dexamethasone; IMiD, immunomodulatory drug; Len, lenalidomide; MPT, melphalan, prednisone, and thalidomide; PAD, bortezomib, doxorubicin, and dexamethasone; PegLD, pegylated liposomal doxorubicin; PN, peripheral neuropathy; Thal, thalidomide; VCD, bortezomib, cyclophosphamide, and dexamethasone; VD, bortezomib and dexamethasone; VMP, bortezomib, melphalan, and prednisone; VMPT, bortezomib, melphalan, prednisone, and thalidomide; VTD, bortezomib, thalidomide, and dexamethasone.