Multiple Myeloma Treatment Regimens

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MULTIPLE MYELOMA TREATMENT REGIMENS

The selection, dosing, and administration of anticancer agents and the management of associated toxicities are complex. Drug dose modifications and schedule and initiation of supportive care interventions are often necessary because of expected toxicities and because of individual patient variability, prior treatment, and comorbidities. Thus, the optimal delivery of anticancer agents requires a healthcare delivery team experienced in the use of such agents and the management of associated toxicities in patients with cancer. The cancer treatment regimens below may include both FDA-approved and unapproved uses/regimens and are provided as references only to the latest treatment strategies. Clinicians must choose and verify treatment options based on the individual patient.

NOTE: Grey shaded boxes contain updated regimens.

General treatment note: Exposure to myelotoxic agents—including alkylating agents and nitrosoureas—should be limited to avoid compromising stem-cell reserve prior to stem-cell harvest in patients who may be candidates for transplant.1

References

  1. NCCN Clinical Practice Guidelines in Oncology™. Multiple Myeloma. v 1.2012. Available at: http://www.nccn.org/professionals/physician_gls/pdf/myeloma.pdf. Accessed March 9, 2012.

  2. Avet-Loiseau H, Leleu X, Roussel M, et al. Bortezomib plus dexamethasone induction improves outcome of patients with t(4;14) myeloma but not outcome of patients with del(17p). J Clin Oncol. 2010;28:4630–4634.

  3. Harousseau JL, Attal M, Avet-Loiseau H, et al. Bortezomib plus dexamethasone is superior to vincristine plus doxorubicin plus dexamethasone as induction treatment prior to autologous stem cell transplantation in newly diagnosed multiple myeloma: results of the IFM 2005-01 phase III trial. J Clin Oncol. 2010;28:4621–4629.

  4. Sonneveld P, Schmidt-Wolf I, van der Holt B, et al. HOVON-65/GMMG-HD4 randomized phase III trial comparing bortezomib, doxorubicin, dexamethasone (PAD) Vs VAD followed by high-dose melphalan (HDM) and maintenance bortezomib or thalidomide in patients with newly diagnosed multiple myeloma [abstract]. Blood. 2010;116:Abstract 40.

  5. Cavo M, Tacchetti P, Patriarca F, et al; GIMEMA Italian Myeloma Network. Bortezomib with thalidomide plus dexamethasone compared with thalidomide plus dexamethasone as induction therapy before, and consolidation therapy after, double autologous stem-cell transplantation in newly diagnosed multiple myeloma: a randomised phase 3 study. Lancet. 2010;376:2075–2085.

  6. Rajkumar SV, Jacobus S, Callander NS, et al; Eastern Cooperative Oncology Group. Lenalidomide plus high-dose dexamethasone versus lenalidomide plus low-dose dexamethasone as initial therapy for newly diagnosed multiple myeloma: an open-label randomised controlled trial. Lancet Oncol. 2010;11:29–37.

  7. San Miguel JF, Schlag R, Khuageva NK, et al. Bortezomib plus melphalan and prednisone for initial treatment of multiple myeloma. N Engl J Med. 2008;359:906–917.

  8. Mateos MV, Richardson PG, Schlag R, et al. Bortezomib plus melphalan and prednisone compared with melphalan and prednisone in previously untreated multiple myeloma: updated follow-up and impact of subsequent therapy in the phase III VISTA trial. J Clin Oncol. 2010;28:2259–2266.

  9. Mateos MV, Oriol A, Martínez-López J, et al. Bortezomib, melphalan, and prednisone versus bortezomib, thalidomide, and prednisone as induction therapy followed by maintenance treatment with bortezomib and thalidomide versus bortezomib and prednisone in elderly patients with untreated multiple myeloma: a randomised trial. Lancet Oncol. 2010;11:934–941.

10. Palumbo A, Dimopoulos MA, Delforge M, et al. A phase III study to determine the efficacy and safety of lenalidomide in combination with melphalan and prednisone (MPR) in elderly patients with newly diagnosed multiple myeloma [abstract]. Blood. 2009;114:Abstract 613.

11. Palumbo A, Delforge M, Catalano J, et al. A phase III study evaluating the efficacy and safety of lenalidomide combined with melphalan and prednisone in patients ≥65 years with newly diagnosed multiple myeloma: continuous use of lenalidomide vs fixed-duration regimens [abstract]. Blood. 2010;116:Abstract 622.

REGIMEN

DOSING

Primary Therapy for Transplant Candidates

Bortezomib (Velcade) + dexamethasone1–3

Days 1, 4, 8, 11: Bortezomib 1.3mg/m2.

Days 1–4 (all cycles) and Days 9–12 (cycles 1 and 2): Dexamethasone 40mg orally.

Repeat cycle every 3 weeks for 4 cycles.

Bortezomib + doxorubicin (Adriamycin) + dexamethasone1,4

Days 1, 4, 8, 11: Bortezomib 1.3mg/m2.

Days 1–4: Doxorubicin 9mg/m2.

Days 1–4, 9–12, 17–20: Dexamethasone 40mg orally.

Repeat cycle every 3 weeks for 3 cycles.

Bortezomib + thalidomide (Thalomid) + dexamethasone1,5

Days 1, 4, 8, 11: Bortezomib 1.3mg/m2.

Days 1, 2, 4, 5, 8, 9, 11, 12: Dexamethasone 40mg orally.

Days 1–14: Thalidomide 100mg orally then escalate 200mg thereafter.

Repeat cycle every 3 weeks for 3 cycles.

Lenalidomide (Revlimid) + dexamethasone1,6

Days 1–21: Lenalidomide 25mg orally once daily, plus

Days 1, 8, 15 and 22: Dexamethasone 40mg/day orally.

Repeat cycle every 4 weeks for 4 cycles or until disease progression.

Primary Therapy for Non-Transplant Candidates

Lenalidomide + dexamethasone1,6

Days 1–21: Lenalidomide 25mg orally once daily, plus

Days 1, 8, 15 and 22: Dexamethasone 40mg/day orally.

Repeat cycle every 4 weeks for 4 cycles or until disease progression.

MPB (melphalan [Alkeran] + prednisone + bortezomib)1,7,8

Days 1–4: Melphalan 9mg/m2 orally.

Days 1–4: Prednisone 60mg/m2 orally.

Cycles 1–4

Days 1, 4, 8, 11, 22, 25, 29, 32: Bortezomib 1.3mg/m2.

Cycles 5–9

Days 1, 8, 22, 29: Bortezomib 1.3mg/m2.

Repeat cycle every 6 weeks for up to 9 cycles.

Melphalan + prednisone + thalidomide1,9

Days 1–7: Melphalan 4mg/m2.

Days 1–7: Prednisone 40mg/m2 orally.

Repeat cycle every 6 weeks for 12 cycles, plus

Days 1–7: Thalidomide 100mg/day orally.

Repeat every 4 weeks.

Melphalan + prednisone + lenalidomide1,10,11

Days 1–4: Melphalan 0.18mg/kg.

Days 1–4: Prednisone 2mg/kg orally.

Days 1–21: Lenalidomide 10mg.

Repeat every 4 weeks for 9 cycles (followed by maintenance lenalidomide 10mg/day).


Hematologic Cancer Drug Monographs

Leukemias, Lymphomas, And Other Hematologic Cancers

Adcetris Adriamycin Adriamycin solution
Alkeran Alkeran for injection Aredia
Arranon Arzerra Bexxar
Bicnu Busulfex Campath
Ceenu Cerubidine Clolar
Cytarabine Dacogen Depocyt
Doxil DTIC-Dome Elspar
Fludara Folotyn Gleevec
Hydrea Idamycin Idamycin PFS
Intron A Intron A Soln Intron A Soln Multidose Pens
Istodax Leukeran Leustatin
Matulane Methotrexate for injection Methotrexate injection
Mustargen Myleran Mylotarg
Novantrone Oforta Oncaspar
Ontak Pentostatin Purinethol
Revlimid Rituxan Sprycel
Tabloid Targretin Targretin gel
Tasigna Thalomid Treanda
Trexall Trisenox Uvadex
Velcade Vesanoid Vidaza
Vinblastine for injection Vinblastine injection Vincasar PFS
Vumon Zevalin Zolinza
Zometa


Data provided by the Monthly Prescribing Reference (MPR) Hematology/Oncology Edition.
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