Among patients with Waldenström macroglobulinemia (WM), adding bortezomib to a dexamethasone, rituximab, and cyclophosphamide (DRC) combination does not appear to improve progression-free survival (PFS), according to research published in the Journal of Clinical Oncology.
Although Bruton tyrosine kinase inhibitors are frequently used, DRC is also a mainstay in patients with WM, as anti-cancer activity is high and the rate of grade 3 or 4 adverse events (AEs) is low. For this randomized study, researchers compared the safety and efficacy of first-line bortezomib-DRC vs DRC among patients with WM.
Overall, 202 patients were randomly assigned to DRC (100 patients) or bortezomib-DRC (102 patients). In the DRC vs bortezomib-DRC groups, the median ages were 68.3 vs 68 years, respectively, 67% vs 67% of patients were male sex, and 60% vs 60% of patients had bone marrow infiltration.
The median follow-up was 27.5 months. At this point, the estimated 24-month PFS rate was 80.6% in the bortezomib-DRC group vs 72.8% in the DRC group (P =.32). Furthermore, major responses — defined at least a partial response — were noted in 80.6% of patients in the B-DRC group vs 69.9% in the DRC group (P =.1).
Overall, 90.6% vs 91.9% of patients in the DRC vs bortezomib-DRC groups, respectively, had any AE. More patients, however, in the DRC group had a serious AE (27.1% vs 14.1% in the B-DRC group).
“Taken together, DRC remains an important treatment option in WM,” the authors wrote in their report. “In patients with a need of rapid response not suffering from WM-associated neuropathy, addition of bortezomib to DRC might be an attractive therapy, always weighing the more rapid and deeper responses achieved by this regimen against potential neurotoxicity.”
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, or device companies. Please see the original reference for a full list of authors’ disclosures.
Buske C, Dimopoulos MA, Grunenberg A, et al. Bortezomib-dexamethasone, rituximab, and cyclophosphamide as first-line treatment for Waldenström’s macroglobulinemia: a prospectively randomized trial of the European consortium for Waldenström’s macroglobulinemia. J Clin Oncol. Published online February 10, 2023. doi:10.1200/JCO.22.01805