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ASCO 2014: Treatment of relapsed/refractory multiple myeloma with weekly cyclophosphamide plus bortezomib plus prednisone or dexamethasone (CyBor-P/D): Updated experience at Princess Margaret Cancer Centre (PMCC)

Donna Reece, MD
Princess Margaret Cancer Centre
Toronto, Ontario, Canada

06.16.14

Abstract No: e19568

Background: We previously defined the efficacy of CyBor-P, a 28-day regimen consisting of cyclophosphamide 300 mg/m2 (days 1,8,15, 22), bortezomib 1.5 mg/m2 (days 1,8, 15) and prednisone 100 mg q 2 days in a phase I/II trial involving patients (pts) with relapsed/refractory multiple myeloma (rel/refr MM) [Reece et al, JCO 2008; 26; 4777]. Variations of this regimen have since been reported (bortezomib weekly and replacement of prednisone with dexamethasone), along with its use as first-line therapy.

Methods: We now retrospectively review our PMCC experience with CyBor-P/D in rel/refr pts who received ≥ 1 cycle of this regimen to gauge its effectiveness in the real-world setting.

Results: Between 2007 and 2013, 98 pts with rel/refr MM received CyBor-P (prednisone 50-100 mg q 2 days) or CyBor-D (dexamethasone 20-40 mg/wk). Median age was 64 yrs (36-86); median # prior regimens was 2 (1-6), including ASCT (75%), bortezomib (28%) and IMiDs (85%). Median creatinine was 94 umol/L (range 53-900). Pts received a median of 5 cycles (range 1-47). Overall response rate (ORR) was 68%, with 42% achieving ≥ VGPR; 24% had stable disease. Median PFS was 14.9 mos (95% CI 12-17.9) and OS 24.2 mos (95% CI 20.2-28.1). Reasons for discontinuation included: progression (44%), planned 2ndASCT (11%), neuropathy (5%), cytopenias (4%), other (5%). The Table shows outcomes according to prior bortezomib exposure. There were no significant outcome differences between bortezomib-naïve pts, or pts treated at first vs. > first relapse. Cytogenetic data was incomplete but 9/15 (60%) del13q and 3/6 (50%) t(4;14) pts responded.

Conclusions: 1) The ORR of 68% and PFS of 14.5 mos seen with CyBor-P/D in the real-world setting compare favorably with other 3-drug regimens; 2) CyBor-P/D is well-tolerated; 3) This regimen is effective as re-treatment in bortezomib-exposed pts. 


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ASCO 2014: Treatment of relapsed/refractory multiple myeloma with weekly cyclophosphamide plus bortezomib plus prednisone or dexamethasone (CyBor-P/D): Updated experience at Princess Margaret Cancer Centre (PMCC)
ASCO 2014: A phase I study of carfilzomib, lenalidomide, vorinostat, and dexamethasone (QUAD) in relapsed and/or refractory multiple myeloma (MM)
ASCO 2014: SWOG 1211: A randomized phase I/II study of optimal induction therapy for newly diagnosed high-risk multiple myeloma (HRMM)
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Myeloma Minute
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