With new therapies for multiple myeloma getting ever better, is transplant still necessary? For now, it seems the answer is yes.
Up-front treatment with high-dose chemotherapy and autologous stem cell transplant (ASCT) is the current standard of care for younger, fit patients. Evidence from randomized trials show that ASCT improves survival in comparison with chemotherapy alone. But what about novel targeted therapies?
In the first large trial to compare a targeted therapy regimen based on bortezomib (Velcade, Millennium Pharmaceuticals, Inc) with transplant, up-front ASCT showed a significant reduction in the risk for progression, said lead study author Michele Cavo, MD, head of the Seràgnoli Institute of Hematology at the University of Bologna, Italy.
Dr Cavo was speaking at a press briefing held in advance of the American Society of Clinical Oncology (ASCO) 2016 Annual Meeting in Chicago.
Although median progression-free survival (PFS) has not yet been reached, patients in the ASCT arm had a 24% lower risk for disease progression at any future time point in comparison with those receiving the bortezomib regimen.
"These preliminary results support the up-front use of high-dose chemotherapy and transplantation, and it continues to be the best treatment option for fit patients with newly diagnosed myeloma, even in the era of novel agents," he said.
New Drugs Need Evaluation
It is unlikely that these new results will settle the wider debate of whether transplant is still needed in the era of novel targeted agents, according to Richard Schilsky, MD, ASCO chief medical officer and former chief of the Section of Hematology-Oncology at the University of Chicago.
"This won't settle the issue, mostly because there a whole slew of newer agents that have been introduced since bortezomib that are even more effective, so how those drugs compare to a transplant-based regimen remains to be seen," Dr Schilsky said in an interview.
Bortezomib is a proteasome inhibitor that was approved by the US Food and Drug Administraiton in 2008 for first-line treatment of multiple myeloma. It is now part of standard treatment regimens for patients with newly diagnosed disease, whether or not they are able to undergo ASCT.
But since the approval of bortezomib, four new agents have come on the market. All four were approved in the United States last year:
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