Bortezomib in multiple myeloma: a practice guideline

Area of Science:

• Hematology
• Oncology
• Pharmacology

Background:

• Bortezomib is a proteasome inhibitor used in multiple myeloma treatment.
• Existing research explores bortezomib alone and in combination therapies.
• There was a need for a provincial guideline on bortezomib use.

Purpose of the Study:

• To develop a provincial guideline for bortezomib use in multiple myeloma.
• To cover newly diagnosed and relapsed/refractory patient populations.
• To include both transplant-eligible and ineligible patients.

Main Methods:

• Systematic literature review of MEDLINE, EMBASE, Cochrane Library, and meeting abstracts.
• Outcomes assessed included survival, disease control, response rates, quality of life, and adverse events.
• Guideline development involved evidence assessment, consensus interpretation, and practitioner validation by the Cancer Care Ontario Hematology Disease Site Group (CCO HDSG).

Main Results:

• Bortezomib-based combinations are recommended for previously untreated multiple myeloma patients, both transplant-eligible and ineligible.
• Bortezomib, alone or in combination, is recommended for relapsed/refractory multiple myeloma.
• No specific subgroup of myeloma patients was identified for unique targeting with bortezomib.

Conclusions:

• Bortezomib is recommended for previously untreated and relapsed/refractory multiple myeloma patients.
• Guidelines provide recommendations for monitoring and mitigating treatment toxicity.
• The guideline addresses dosing, cytopenias, and prevention of toxicities like herpes zoster reactivation.