Bortezomib-based therapy in non-transplant multiple myeloma patients: a retrospective cohort study from the FABIO project

Bortezomib advanced mechanisms of action in multiple myeloma, solid and liquid tumors along with its novel therapeutic applications

Bortezomib (BTZ) is a first-in-class reversible and selective proteasome inhibitor. It inhibits the ubiquitin proteasome pathway that leads to the degradation of many intracellular proteins. Initially, BTZ was FDA approved for the treatment of refractory or relapsed multiple myeloma (MM) in 2003. Later, its usage was approved for patients with previously untreated MM. In 2006, BTZ was approved for the treatment of relapsed or refractory Mantle Cell Lymphoma (MCL) and, in 2014, for previously untreated MCL. BTZ has been extensively studied either alone or in combination with other drugs for the treatment of different liquid tumors especially in MM. However, limited data evaluated the efficacy and safety of using BTZ in patients with solid tumors. In this review, we will discuss the advanced and novel mechanisms of action of BTZ documented in MM, solid tumors and liquid tumors. Moreover, we will shed the light on the newly discovered pharmacological effects of BTZ in other prevalent diseases.

Treatment Outcomes with Reduced-Dose Bortezomib in Adult Patients with Multiple Myeloma: A Single-Center Experience

Objectives Bortezomib vial-sharing is commonly employed to maximize the treatment of patients with multiple myeloma (MM) in resource-limited setting. This strategy minimizes delays in treatment but reduces the dose of bortezomib received by the patient. Herein, we aimed to determine the treatment patterns and outcomes in Filipino patients with MM who received reduced-dose bortezomib.

Methods The records of 47 adult patients with MM, seen at our institution from 2016 to 2019 and treated with reduced-dose bortezomib, were retrospectively reviewed.

Results The median age of the patients at diagnosis was 55 years; 59.6% were male. VCD (bortezomib, cyclophosphamide, dexamethasone) regimen was the most commonly used (70.7%) bortezomib-based treatment. Among the newly diagnosed patients, bortezomib-based treatment afforded an overall response rate of 79.3%. The median overall survival was not reached. Univariate analysis showed that the hemoglobin level affected response while age, hemoglobin and calcium levels, the choice of induction regimen, and the depth of response all had an impact on survival.

Conclusion This study is the first to investigate the real-world outcomes of reduced-dose bortezomib in MM treatment and may provide initial evidence that bortezomib vial-sharing is an acceptable strategy in the treatment of MM in resource-limited setting.