Mohan Meera, Matin Aasiya, Davies Faith E
Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Cancer Manag Res. 2017 Mar 2;9:51-63. doi: 10.2147/CMAR.S105163. eCollection 2017.
The proteasome inhibitor (PI) "bortezomib" has now been in routine clinical practice for over a decade. It is now considered an important backbone therapy for all stages of the disease, and data continue to grow to support its use in newly diagnosed patients, relapsed and relapsed/refractory disease, maintenance therapy, high risk, and renal failure. Much has been learnt about the most clinically effective way of delivering therapy, with patients often benefiting more from a triplet bortezomib combination compared to a doublet combination. It is well tolerated and can be administered in the outpatient setting with manageable toxicity. The key to good results is managing side effects so that patients remain on therapy with minimal interruptions. Therefore, proactive management of peripheral neuropathy and thrombocytopenia is advised using dose delay and reduction strategies. The recent introduction of second- and third-generation PIs with different chemical and biological properties has resulted in a plethora of new clinical studies and has confirmed the ongoing role of this class of drugs in future myeloma therapy.
蛋白酶体抑制剂（PI）“硼替佐米”已在常规临床实践中应用了十多年。目前，它被视为针对该疾病各个阶段的重要基础治疗药物，并且支持其用于新诊断患者、复发及复发/难治性疾病、维持治疗、高危患者及肾衰竭患者的数据持续增加。关于提供治疗的最具临床疗效的方法，我们已经了解了很多，与双联组合相比，患者通常从三联硼替佐米组合中获益更多。它耐受性良好，可在门诊环境中给药，毒性易于管理。取得良好疗效的关键在于管理副作用，使患者能够在治疗过程中尽量减少中断。因此，建议采用剂量延迟和减少策略，对周围神经病变和血小板减少症进行积极管理。最近引入的具有不同化学和生物学特性的第二代和第三代蛋白酶体抑制剂引发了大量新的临床研究，并证实了这类药物在未来骨髓瘤治疗中持续发挥的作用。
