Primary treatment of multiple myeloma with thalidomide, vincristine, liposomal doxorubicin and dexamethasone (T-VAD doxil): a phase II multicenter study
| Autor: | A. Anagnostopoulos, J. Korantzis, Alice Maniatis, Meletios A. Dimopoulos, E. Hatzicharissi, Konstantinos Zervas, Maria Papaioannou, Ch. Mitsouli, P. Panagiotidis, M. Tzilianos |
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| Rok vydání: | 2003 |
| Předmět: |
Adult
Male medicine.medical_specialty Vincristine medicine.medical_treatment VAD Regimen Neutropenia Gastroenterology Transplantation Autologous Dexamethasone Drug Administration Schedule Internal medicine Antineoplastic Combined Chemotherapy Protocols Ambulatory Care Medicine Humans Multiple myeloma Aged Chemotherapy business.industry Hematology Middle Aged medicine.disease Surgery Thalidomide Regimen Treatment Outcome Oncology Doxorubicin Injections Intravenous Female business Multiple Myeloma medicine.drug Stem Cell Transplantation |
| Zdroj: | Annals of oncology : official journal of the European Society for Medical Oncology. 15(1) |
| ISSN: | 0923-7534 |
| Popis: | Background High-dose chemotherapy with autologous stem cell transplantation after initial cytoreductive chemotherapy with the combination vincristine, doxorubicin and dexamethasone (VAD) is considered an effective therapy for many patients with newly diagnosed, symptomatic multiple myeloma. Response to initial cytoreductive chemotherapy is important for the long-term outcome of such patients. Thalidomide has recently shown significant antimyeloma activity. We studied the efficacy and toxicity of the combination of a liposomal doxorubicin-containing VAD regimen with thalidomide, administered on an outpatient basis, as initial cytoreductive treatment in previously untreated patients with symptomatic myeloma. Patients and methods Thirty-nine myeloma patients were treated with vincristine 2 mg intravenously (i.v.), liposomal doxorubicin 40 mg/m2 i.v. administered as single dose on day 1, and dexamethasone 40 mg per os daily for 4 days. Dexamethasone was also given on days 15–18 of the first cycle of treatment. The regimen was administered every 4 weeks for four courses. Thalidomide was given daily at a dose of 200 mg at bedtime. Response to treatment was evaluated after four cycles of treatment. After completion of four cycles, the patients were allowed to proceed to high-dose chemotherapy or to receive two additional cycles of the same treatment. Results On an intention-to-treat basis, 29 of the 39 patients (74%) responded to treatment. Four patients (10%) achieved complete and 25 (64%) partial response. Three patients (8%) showed minor response and seven (18%) were rated as non-responders. Major grade 3 or 4 toxicities consisted of neutropenia (15%), thrombocytopenia (15%), deep vein thrombosis (10%), constipation (10%), skin rash (5%) and peripheral neuropathy (5%). Two patients (5%) experienced early death due to infection. Conclusions The combination of vincristine, liposomal doxorubicin, and dexamethasone (VAD doxil) with thalidomide is an effective and relatively well-tolerated initial cytoreductive treatment.Prospective randomized studies are required in order to assess the effect of this regimen on the long-term outcome of patients with multiple myeloma. |
| Databáze: | OpenAIRE |
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