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      Bortezomib therapy in a real-world setting in patients with relapsed or refractory multiple myeloma

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          Abstract

          Bortezomib is a proteasome inhibitor, approved for treating newly diagnosed and relapsed multiple myeloma (MM). This realworld, multicenter, observational, non-interventional study of bortezomib was designed to collect and analyze prospective data in Taiwanese patients with relapsed or refractory MM. The primary endpoints included clinical effectiveness outcomes (disease response, disease progression [PD], time-to-response, time-toprogression, response duration, and overall survival [OS]). Secondary endpoints were safety and healthcare resource utilization.

          Total 100 patients (median [range] age 64.9 [37.0-85.5] years) were enrolled; 47 patients completed the study. Of the withdrawn patients (n=53), there were 48 deaths (PD-related death: n=35, adverse events [AEs]-related: n=12, other reason: n=1), and 5 due to loss to follow-up. Four patients in Cycle 1, 6 patients each in Cycle 2 and 5, 7 in Cycle 3, 10 patients in Cycle 4, 5 patients in Cycle 6, and 3 patients each in Cycle 7 and 8 achieved overall response during the study. Time-to-response was 4.68 months (95%CI: 3.2, NE) and response duration was 10.08 months (95%CI: 2.3, 28.6). Median OS was 9.8 months (95%CI: 3.8, 13.7), and median time-to-progression was 11.3 months (95%CI: 6.2, 20.2). Most common non-hematological AEs were diarrhea (n=32) and hypoesthesia (n=25); most common hematological AE was thrombocytopenia (n=18).

          Efficacy and safety profile of bortezomib in Taiwanese patients with MM was similar to global and other Asian population. Study provides a critical insight on use of bortezomib in realworld clinical practice, which can be helpful for Taiwanese healthcare providers’ decision-making processes.

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          Most cited references18

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          Criteria for evaluating disease response and progression in patients with multiple myeloma treated by high-dose therapy and haemopoietic stem cell transplantation. Myeloma Subcommittee of the EBMT. European Group for Blood and Marrow Transplant.

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            Velcade: U.S. FDA approval for the treatment of multiple myeloma progressing on prior therapy.

            Bortezomib (formerly PS-341), a promising new drug for the treatment of multiple myeloma, recently received accelerated approval from the U.S. Food and Drug Administration (FDA) for the therapy of patients with progressive myeloma after previous treatment. Two phase II studies of bortezomib used the same schedule of twice-weekly i.v. dosing for the first 2 weeks of each 3-week cycle. In a randomized study of 54 patients, two doses were compared (1.0 and 1.3 mg/m2) and objective responses occurred at both dose levels (23% versus 35%), including one complete response in each arm. In the other phase II study, 202 heavily pretreated patients (median of six prior therapies) all received the same schedule at 1.3 mg/m2. Of 188 evaluable patients, complete responses occurred in five (3%) and partial responses occurred in 47 (25%). The median duration of response was 365 days. The most clinically relevant adverse events were asthenic conditions, nausea, vomiting, diarrhea, thrombocytopenia, and a peripheral neuropathy that often was painful. This report highlights the FDA analysis supporting the accelerated approval.
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              Bortezomib for the treatment of mantle cell lymphoma.

              To describe the Food and Drug Administration review and marketing approval considerations for bortezomib (Velcade) for the treatment of patients with mantle cell lymphoma. Food and Drug Administration reviewed a multicenter study of bortezomib in 155 patients with progressive mantle cell lymphoma after at least one prior therapy. Seventy-seven percent were stage IV, and 75% had one or more extranodal sites of disease. Prior therapy included an anthracycline or mitoxantrone, cyclophosphamide, and rituximab. Median age was 65 years. All received bortezomib 1.3 mg/m(2) i.v. on days 1, 4, 8, and 11 of each 3-week cycle. The primary end point was response. Response and progression were determined by independent review of serial computed tomography scans using International Lymphoma Workshop Response Criteria. The overall response rate was 31%, including complete response (CR) plus CR unconfirmed (CRu) plus partial response; median response duration was 9.3 months. The CR plus CRu response rate was 8% with a median duration of 15.4 months. Adverse events were similar to those observed previously for bortezomib. The most commonly reported treatment-emergent adverse events were asthenia (72%), peripheral neuropathies (55%), constipation (50%), diarrhea (47%), nausea (44%), and anorexia (39%). The most common adverse event leading to discontinuation was neuropathy. Bortezomib received regular approval for the treatment of patients with mantle cell lymphoma in relapse after prior therapy.
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                Author and article information

                Journal
                Oncol Rev
                Oncol Rev
                ONCOL
                Oncology Reviews
                PAGEPress Publications, Pavia, Italy
                1970-5565
                1970-5557
                18 January 2019
                14 January 2019
                : 13
                : 1
                : 377
                Affiliations
                [1 ]National Taiwan University Hospital , Taiwan
                [2 ]National Cheng Kung University Hospital , Taiwan
                [3 ]Kaohsiung Chang Gung Memorial Hospital , Taiwan
                [4 ]Tri-Service General Hospital, National Defense Medical Center , Taiwan
                [5 ]Kaohsiung Medical University Memorial Hospital
                [6 ]Mackay Memorial Hospital , Taiwan
                [7 ]Johnson & Johnson Investment Ltd , Shanghai, P.R. China
                [8 ]Janssen Medical Affairs , Taiwan
                [9 ]Chang-Hua Christian Hospital , Taiwan
                Author notes
                Changhua Christian Hospital, Changhua City, Changhua County, Taiwan. 886.47000626. cs4816@ 123456gmail.com

                Contributions: all named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

                Conflict of interests: Dr Betty Yang is employee of Johnson & Johnson Taiwan Ltd.

                Registration: VELCADE® Observational Study Protocol 26866138MMY4055

                Compliance with ethics guidelines: the study was conducted in accordance with the ethical principles that have their origin in the Declaration of Helsinki, consistent with Good Clinical Practices and applicable regulatory requirements. The study protocol and informed consent form were reviewed and approved by the Institutional Review Boards and/or Independent Ethics Committee at all sites. All enrolled patients provided written informed consent for their participation in the study.

                Article
                10.4081/oncol.2019.377
                6379781
                741c7770-475a-4ce0-9892-fe350d861baf
                ©Copyright S-Y. Huang et al., 2019

                This work is licensed under a Creative Commons Attribution NonCommercial 4.0 License (CC BY-NC 4.0).

                History
                : 12 June 2018
                : 22 October 2018
                Page count
                Figures: 4, Tables: 4, Equations: 0, References: 30, Pages: 8
                Funding
                Funding: this study was sponsored by Johnson & Johnson Taiwan Ltd.
                Categories
                Review

                bortezomib,effectiveness,multiple myeloma,observational,real-world

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