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Efficacy of single‐agent bortezomib vs. single‐agent thalidomide in patients with relapsed or refractory multiple myeloma: a systematic comparison
Author(s) -
Prince H. Miles,
Adena Michael,
Smith Dell Kingsford,
Hertel Judy
Publication year - 2007
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/j.1600-0609.2007.00886.x
Subject(s) - thalidomide , bortezomib , multiple myeloma , medicine , refractory (planetary science) , oncology , lenalidomide , biology , astrobiology
Objective: To conduct a systematic review of the efficacy of single‐agent bortezomib vs. single‐agent thalidomide in patients with relapsed/refractory multiple. Methods: Publications in English from 1966 to June 2005 (MEDLINE, EMBASE, Cochrane library), publication reference lists, Janssen‐Cilag data‐on‐file and abstracts from recent multiple myeloma conferences were reviewed. Prospective studies containing at least a single arm of either treatment group with n ≥30 were included. Studies adding dexamethasone for non‐responders were excluded. Statistical pooling was performed for response rate and overallsurvival. Results: One bortezomib study ( n = 333, NEJM 2005, 352; 2487–98) and 15 thalidomide ( n = 1007) studies met these criteria and were included. Patient baseline characteristics including age, gender, IgG : IgA, disease duration and beta‐2 microglobulin were well matched except that 48% of bortezomib patients had received prior thalidomide. Response rate, defined as serum M‐protein reduction ≥50%, was 53% for patients receiving bortezomib vs. 32% for thalidomide ( P < 0.001, n = 10 studies). Response rate determined by European Group for Blood and Marrow Transplantation (EBMT) criteria was 41% for patients receiving bortezomib vs. 22% for thalidomide ( P < 0.001, n = 4 studies). Conclusion: Bortezomib was associated with a significantly higher response rate and complete remission rate using both M‐protein and EBMT criteria.