Lancaster Simon
SL Comm Ltd, Macclesfield, UK.
Core Evid. 2006;1(4):265-77. Epub 2006 Jun 30.
Multiple myeloma is a relatively common and incurable form of hematologic malignancy for which there is currently no single standard therapy. Bortezomib inhibits the 20S proteasome involved in the degradation of intracellular proteins, induces apoptosis, reverses drug resistance in multiple myeloma cells, and influences their microenvironment by blocking cytokine circuits, cell adhesion and angiogenesis in vivo.
The objective of this review is to evaluate the evidence for the use of bortezomib in the treatment of multiple myeloma.
In patients with relapsed multiple myeloma bortezomib significantly prolongs overall survival and time to progression, and improves response rates, duration of response, and quality of life compared with oral high-dose dexamethasone. Although the incidence of grade 4 adverse events was similar, grade 3 events and herpes zoster infections occur more frequently in patients treated with bortezomib than with high-dose dexamethasone. Evidence from a pharmacoeconomic study indicates that the benefits of bortezomib compared to thalidomide plus best standard care may be achieved at a reasonable cost.
Bortezomib is a valuable treatment option in the management of relapsed multiple myeloma that improves survival and delays disease progression compared with oral high-dose dexamethasone treatment, albeit with an increased incidence of some adverse events such as grade 3 thrombocytopenia and neutropenia.
多发性骨髓瘤是一种相对常见且无法治愈的血液系统恶性肿瘤，目前尚无单一的标准治疗方法。硼替佐米抑制参与细胞内蛋白质降解的20S蛋白酶体，诱导细胞凋亡，逆转多发性骨髓瘤细胞的耐药性，并通过阻断体内细胞因子回路、细胞黏附和血管生成来影响其微环境。
本综述的目的是评估硼替佐米用于治疗多发性骨髓瘤的证据。
在复发的多发性骨髓瘤患者中，与口服高剂量地塞米松相比，硼替佐米显著延长总生存期和疾病进展时间，并提高缓解率、缓解持续时间和生活质量。虽然4级不良事件的发生率相似，但硼替佐米治疗的患者中3级事件和带状疱疹感染的发生率高于高剂量地塞米松治疗的患者。一项药物经济学研究的证据表明，与沙利度胺加最佳标准治疗相比，硼替佐米的益处可能以合理的成本实现。
硼替佐米是复发多发性骨髓瘤管理中的一种有价值的治疗选择，与口服高剂量地塞米松治疗相比，可提高生存率并延缓疾病进展，尽管某些不良事件如3级血小板减少症和中性粒细胞减少症的发生率有所增加。
