St. Vincent's Comprehensive Cancer Center
New York, NY, USA
NOTE: The IMF did not receive permission to publish Dr. Jagannath's slides or audio, so we are bringing you a summary of his presentation by our medical writer, Lynne Lederman, PhD.
SUMMARY: Dr. Jagannath believes that OS is the ultimate gold standard, and that attempts to increase the CR rate after induction (pre-transplant) will improve the CR rate post-transplant, and will eventually increase OS. In phase 2 trials, bortezomib as frontline therapy in various combinations has resulted in high CR rates both before and after high dose chemotherapy, and appears to overcome the high risk cytogenetics including chromosome 13 deletion, Rb deletion, and t(4;14). The use of bortezomib with pegylated liposomal doxorubicin (Doxil) allows a steroid-sparing regimen that Dr. Jagannath noted has a response rate almost as good as the combination of bortezomib plus doxorubicin plus dexamethasone. He noted that the use of thalidomide as a short induction platform was not as good as that seen with bortezomib. Induction therapy with novel agents has increased the post-transplantation CR rate, reduced the need for second transplants, but an increase in progression-free survival (PFS) and OS needs to be demonstrated. Nevertheless, there is a role for integration of bortezomib into high dose therapy as an induction regimen.