Personalized Sequential Multiple Myeloma Regimen Shows Promise in Older, Frail Patients

In a phase II prospective clinical trial, researchers evaluated the effectiveness of a personalized sequential therapy for older patients with multiple myeloma, developed based on individuals’ scores on the Vulnerable Elders Survey-13 (VES-13). This study was published in the Annals of Hematology.

“The VES-13 is a well-studied simplified frailty screening tool for elderly patients in the oncology setting,” wrote the study authors. “We conducted a prospective clinical trial to evaluate the efficacy and safety of dose-adjusted treatment based on the VES-13 in transplant-ineligible patients with newly diagnosed multiple myeloma.”

Patients with VES-13 scores of less than three were considered “Fit,” while those with scores greater than or equal to three were considered “Frail.” Sixteen patients were in the Fit subgroup and received four cycles of standard dose VCD (bortezomib, cyclophosphamide, and dexamethasone) followed by four cycles of standard-dose VTD (bortezomib, thalidomide, and dexamethasone). In the Frail subgroup, 31 patients received four cycles of reduced-dose VCD followed by four cycles of reduced-dose VTD. The median patient age was 75 years (range, 66 to 86 years).

Both treatment groups demonstrated comparable response to treatment. The overall response rate among the Fit group was 87.5% and among the Frail group it was 87.1%. The researchers did not identify any significant differences in progression-free survival (PFS) and overall survival (OS) between the Fit and Frail groups. Three-year PFS and OS in the Fit versus Frail groups were 68.8% versus 53.5% (P=0.658) and 70.0% versus 77.6% (P=0.919), respectively.

In conclusion, the authors wrote, “Personalized VCD-VTD sequential therapy based on the VES-13 was associated with high response rates and showed acceptable safety in elderly frail patients with multiple myeloma.”

Reference

Nakazato T, Hagihara M, Sahara N, et al. Phase II clinical trial of personalized VCD-VTD sequential therapy using the Vulnerable Elders Survey-13 (VES-13) for transplant-ineligible patients with newly diagnosed multiple myeloma. Ann Hematol. 2021 Nov;100(11):2745-2754.