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Do anthracyclines have a role in the therapy of multiple myeloma?
Introduction:
There is a great need for alternative treatments for patients with relapsing and refractory multiple myeloma. The new anthracycline idarubicin has the advantage of oral administration and has been suggested as part of new orally based chemotherapeutic combination regimens. The evidence of its own efficacy in this disorder is, however, insufficient.
Materials And Methods:
In a multi-centre phase II study we administered oral idarubicin as a single drug in a dose of 10 mg/m(2) days 1-4 every four weeks to a total of 30 patients with relapsing (n=18) or refractory (n=12) multiple myeloma.
Results:
Of 28 evaluable patients only one achieved a partial response of 15 months' duration. Other patients showed a very short minor response (n=1), "no change" (n=11) or progression (n=15) during the therapy. Toxicity was mostly mild and the drug was fairly well tolerated. None the less, half of the patients experienced WHO grade 3 and 4 toxicity in the form of granulocytopenia (n=10) or thrombocytopenia (n=4).
Conclusion:
Based on our experience and available data from three previously published reports, we consider idarubicin to have only a marginal effect in relapsing and refractory myeloma. A review of the literature on studies of anthracylines as single-agent therapy shows that only 5% of patients (19 out of 377) show a partial response. In our opinion the regular inclusion of an anthracycline in drug combinations for refractory myeloma should be reconsidered.
Insights
Oral idarubicin shows limited efficacy as a single agent for relapsing and refractory multiple myeloma. Further investigation into anthracycline inclusion in combination therapies is warranted.
Area of Science:
- Oncology
- Pharmacology
Background:
- Multiple myeloma requires novel treatments, especially for relapsed or refractory cases.
- Oral idarubicin, an anthracycline, is a potential candidate for oral chemotherapy regimens.
- Evidence for idarubicin's efficacy as a monotherapy in multiple myeloma is limited.
Purpose of the Study:
- To evaluate the efficacy and safety of oral idarubicin as a single agent in patients with relapsing or refractory multiple myeloma.
Main Methods:
- A multi-center, phase II study involved 30 patients with relapsing (n=18) or refractory (n=12) multiple myeloma.
- Patients received oral idarubicin at a dose of 10 mg/m² on days 1-4 every four weeks.
- Efficacy and toxicity were assessed in evaluable patients.
Main Results:
- Only one of 28 evaluable patients achieved a partial response (15-month duration).
- The majority of patients experienced minor responses, no change, or disease progression.
- Grade 3 and 4 toxicity, primarily granulocytopenia and thrombocytopenia, occurred in 50% of patients.
Conclusions:
- Oral idarubicin demonstrates marginal efficacy as a single agent for relapsing and refractory multiple myeloma.
- Literature review indicates a low partial response rate (5%) for anthracyclines as single agents in this condition.
- Reconsideration of routine anthracycline use in combination therapies for refractory myeloma is recommended.