The present trial is designed as a phase II study that aims at estimating the efficacy of the combination of bendamustine, bortezomib and dexamethasone in relapsed/refractory multiple myeloma (MM). The response rate, i.e. the rate of the patients achieving a Complete Response or Partial Response at cycle 4, divided by the total intent to treat patient number is chosen as primary efficacy endpoint. The estimation of the efficacy rate is to be based on an explorative pilot study, since immediate embarking on a large-scale comparative efficacy trial would not be acceptable from the point of view of resources. Moreover, this would induce ethical objections, as it does not seem to be justifiable to expose a large number of patients to an experimental approach without sufficient exploratory indications of an improved risk-benefit ratio.
After relapse or after early progression on first-line treatment, the prognosis of multiple myeloma (MM) patients is unfavourable, and the search for new treatment regimens, including drugs with novel mechanisms of action is essential. Bendamustine and bortezomib have shown high activity boch in first-line regimens and pre-treated patients. The novel mechanism of action of the proteasome inhibitor and the non-cross resistance of bendamustine to other alkylating agents established in the first-line treatment of multiple myeloma seem to recommend a combination of the two drugs for salvage therapy (second-line regimen). Finally, the promising response data in a series of relapsing MM patients treated with bendamustine, bortezomib and prednisone support this assumption, as well as the feasibility and tolerability of the combination. In summary, there is some evidence for a favorable risk/benefit ratio for the combination of bendamustine, bortezomib and a corticoid drug, warranting the exploration in a larger, prospectively designed multicenter phase II study.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
75
Bendamustine : 70 mg/m2 iv on D1 and 8, for each cycle Velcade : 1.3 mg/m2 iv on D1, 8, 15 and 22, for each cycle Dexamethasone : 20 mg/day po on D1, 8, 15 and 22, given prior to Bendamustine and Velcade
CHRU Hôpital Sud
Amiens, France
CHRU, Hôpital du Bocage
Angers, France
Centre Hospitalier H.Duffaut
Avignon, France
Centre Hospitalier de la Cote Basque
Bayonne, France
Hôpital Jean Minjoz / CHU BESANCON
Besançon, France
Centre Hospitalier
To assess of the overall response rate (complete response (CR) + partial response (PR))
Time frame: After four 28-day consecutives cycles
Time to best response
Time frame: the time from treatment start to the first detection of the best response category, calculated for all patients, which are not primarily refractory
Progression-free survival
Time frame: The time form the initial dose of chemotherapy to the time of disease progression or death, or to the date of last assessment without any such event (censored observation)
Time to progression
Time frame: The time from baseline to the development of progressive disease
Overall survival
Time frame: The time interval from initial dose to the date of death or last observation (censored)
Rate of additional response
Time frame: Following 2 consolidation cycles and following 6 maintenance cycles
Toxicity/Adverse events
Time frame: From the time a signed and dated informed consent form is obtained until 60 days following the lase dose of study medication or until the start of a new subsequent antimyeloma therapy
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Blois, France
Hôpital Avicenne
Bobigny, France
Polyclinique Bordeaux Nord Aquitaine
Bordeaux, France
Hôpital A.Morvan
Brest, France
Centre F.Baclesse
Caen, France
...and 27 more locations