Myeloma, Waldenstrom's, and Amyloidosis Program, Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA.
Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA.
Blood Cancer J. 2024 Mar 22;14(1):52. doi: 10.1038/s41408-024-01034-6.
Induction regimens for multiple myeloma (MM) commonly include bortezomib, which has typically been administered twice weekly despite studies demonstrating comparable efficacy and less peripheral neuropathy (PN) with once-weekly bortezomib. We aimed to analyze the real-world prevalence and efficacy of once-weekly versus twice-weekly bortezomib regimens in newly diagnosed MM. We analyzed 2497 US patients aged 18-70 years treated with commercial first-line bortezomib using nationwide Flatiron Health electronic health record-derived data, including 910 (36.4%) patients who received twice-weekly and 1522 (63.2%) who received once-weekly bortezomib. Once-weekly bortezomib use increased over time, from 57.7% in 2017 to 73.1% in 2022. Multivariate analysis identified worsened performance status and more recent year of diagnosis with higher odds of receiving once-weekly bortezomib. Real-world progression-free survival (median 37.2 months with once-weekly versus 39.6 months with twice-weekly, p = 0.906) and overall survival (medians not reached in either cohort, p = 0.800) were comparable. PN rates were higher in patients receiving twice-weekly bortezomib (34.7% versus 18.5%, p < 0.001). In conclusion, once-weekly bortezomib is clearly associated with similar efficacy and fewer toxicities compared to twice-weekly bortezomib. Our findings support once-weekly bortezomib as a standard-of-care regimen for newly diagnosed patients with MM.
多发性骨髓瘤（MM）的诱导方案通常包括硼替佐米，尽管有研究表明每周一次的硼替佐米与每周两次的硼替佐米疗效相当且周围神经病变（PN）发生率较低，但该药物通常每周给药两次。我们旨在分析初诊 MM 中每周一次与每周两次硼替佐米方案的真实世界流行率和疗效。我们分析了使用全国范围内 Flatiron Health 电子健康记录衍生数据治疗的 2497 名年龄在 18-70 岁的美国患者，其中包括 910 名（36.4%）接受每周两次硼替佐米和 1522 名（63.2%）接受每周一次硼替佐米的患者。每周一次硼替佐米的使用随着时间的推移而增加，从 2017 年的 57.7%增加到 2022 年的 73.1%。多变量分析确定较差的表现状态和最近的诊断年份与接受每周一次硼替佐米的可能性更高有关。真实世界的无进展生存期（每周一次为 37.2 个月，每周两次为 39.6 个月，p=0.906）和总生存期（两个队列均未达到中位数，p=0.800）相当。接受每周两次硼替佐米治疗的患者的 PN 发生率更高（34.7%比 18.5%，p<0.001）。总之，与每周两次硼替佐米相比，每周一次硼替佐米显然具有相似的疗效和更少的毒性。我们的发现支持每周一次硼替佐米作为初诊 MM 患者的标准治疗方案。
