Bortezomib (Velcade) in combination with dexamethasone or pegylated liposomal doxorubicin for relapsed multiple myeloma
Bortezomib (Velcade) is intended to be used for the treatment of relapsed multiple myeloma (MM) in combination with dexamethasone or pegylated liposomal doxorubicin (PLD). If licensed, bortezomib with dexamethasone or PLD may provide an additional treatment option for this patient group. Bortezomib is a selective, reversible inhibitor of the 26S proteasome complex. It is currently licensed in the EU as monotherapy for progressive MM in patients who have received at least one prior therapy and who have already undergone, or are unsuitable for, bone marrow transplantation, and for previously untreated MM patients in combination with melphalan and prednisolone.
In 2009, 4,270 people were diagnosed with MM in England and Wales, giving a crude incidence rate of 8 per 100,000 population. This represents around 1% of all cancer diagnoses. The risk of developing MM increases with age; the median age of presentation is 70 years, with only 2% of patients under the age of 40 years. Median survival for MM is approximately 3 to 5 years, though this can increase to a median of 7 years with use of intensive therapy. In 2010, 2,298 deaths from MM were registered in England and Wales, with an average 82% of these deaths occurring in people aged 65 and over.
For patients who are able to tolerate it, the best outcomes are acheived with induction therapy followed by high-dose melphalan and autologous stem cell transplantation. Following relapse, patients are commonly treated with bortezomib and lenalidomide based therapies. Bortezomib with dexamethasone or PLD has completed one phase III trial and is currently in another phase III trial comparing its effect on time to progression against treatment with bortezomib monotherapy. This trial is expected to complete in 2013.