Bortezomib-Based Regimens Compared for Myeloma-Related Acute Kidney Injury
Posted: Friday, August 28, 2020
No difference in renal recovery emerged from the results of a multicenter, randomized controlled trial in France comparing doublet versus triplet bortezomib-based regimens in patients with newly diagnosed multiple myeloma. These patients also had an acute kidney injury caused by cast nephropathy that did not require dialysis. Jean Paul Fermand, MD, of Hôpital Saint Louis, Paris, and colleagues, who reported their findings in the Journal of Clinical Oncology suggest opting in for a doublet or triplet regimen should depend on the frailty of the patient.
Patients were randomly assigned 1:1 to either bortezomib plus dexamethasone or bortezomib/dexamethasone plus cyclophosphamide (n = 92 for each). The median age of patients was 68 years, and serum creatinine level (305.5 and 273.5 µmol/L in the doublet and triplet cohorts, respectively) were similar between the groups.
The trial’s primary endpoint was renal response rate at 3 months, and the rates did not significantly differ, with 41 and 47 responders in the doublet and triplet groups, respectively (P = .46). Renal response is conditioned by drastic reduction in nephrotoxic serum free light chains, the authors noted, and a very good partial response or better, with a free light chain reduction of at least 90%, was achieved in 36 and 47 patients, respectively (P = .10).
At 12 months, 19 patients had died (9 in the doublet group, 10 in the triplet), and that number increased to 50 after a median follow-up of 27 months (24 deaths in the doublet group, 26 in the triplet). “Patients with myeloma with acute kidney injury are fragile, and indication for doublet or triplet regimen should be adapted to frailty,” concluded Dr. Fermand and co-investigators. “The tolerance profile appeared less favorable in the triplet group.”
Disclosure: The study authors’ disclosure information can be found at ascopubs.org.
