A study published on February 3rd, 2020 in the scientific journal Nature Research is highlighting the capability of a three part combination treatment for use in multiple myeloma, a rare and difficult to treat blood cancer. A diverse array of combination therapies are already in use for this disease; common options include bortezomib-cyclophosphamide-dexmathasone and bortezomib-bendamustine-prednisone. The combination tested in this study, which served as a phase 1/2 clinical trial, was carfilzomib, bendamustine, and dexamethasone (CBD).
About Multiple Myeloma
Multiple myeloma, which is occasionally referred to as plasma cell myeloma, is a blood cancer that affects plasma cells. These are white blood cells that produce antibodies. The overall cause of multiple myeloma is not well understood, however, some risk factors have been identified. These include obesity, family history, smoldering myeloma, and monoclonal gammopathy of undetermined significance. These last two conditions have the potential to develop into multiple myeloma. Symptoms of this cancer include bone pain, infections, anemia, kidney failure, overly thick blood, confusion, fatigue, headaches, and amyloidosis. Treatment includes chemo, stem cell transplant, and other medications for relapsed disease, which is common. Five year survival rate is 49 percent in the US. To learn more about multiple myeloma, click here.
The trial included a total of 20 patients with multiple myeloma. All of these patients were recently diagnosed. 16 of these patients underwent eight cycles of treatment with CBD, with others halting treatment earlier due to adverse effects, such as neutropenia and thrombocytopenia. Each cycle lasted 28 days. The combination treatment proved to be effective in the study, and produced an overall response rate of 100 percent. This means that every patient experienced at least a partial response to the treatment.
63 percent of patients saw a complete response to CBD; 26 percent had a very good partial response; 11 percent had a partial response. Of the patients that saw a complete response, four of them did test positive for minimum residual disease (an indicator of an increased risk of relapse). At a follow up of a median 28 months, two patients that received CBD had died and two others had seen their disease progress. Median progression free survival for the study was 56 months.
The findings suggest that the carfilzomib, bendamustine, and dexamethasone combination can be an effective treatment for multiple myeloma, particularly in newly diagnosed patients. One advantage of this approach is that it does not use an immunomodulatory drug. This means that the combination is less costly without sacrificing effectiveness. This also means that immunomodulatory drugs can be held in reserve if or when the patient relapses.