Clinical and Economic Impact of Multiple Myeloma

Matthew P. Mitchell, PharmD, MBA

December 2011, Vol 2, No 7 - VBCC Perspectives


The clinical and economic impact of multiple myeloma is tremendous. With the onset of novel therapies used in multiple myeloma, as well as the release of new data demonstrating progression-free survival and overall survival, therapy used in multiple myeloma is now on the radar for payers, despite the relatively low incidence of the disease.

In addition, contributing to the awareness of payers is the reality that maintenance therapy and multitherapy or combination regimens are becoming very common in the approach to treatment of patients with multiple myeloma. As a result of using newer agents, the 5-year survival rate has increased to 40% for patients diagnosed with this disease between 2001 and 2007.1,2

The data from the VISTA trial reported at the recent American Society of Hematology annual meeting and discussed in the article above are interesting and encouraging in their long-term perspective. The VISTA trial evaluated the safety and efficacy of melphalan and prednisone (MP) therapy versus bortezomib in combination with MP as initial therapy for nontransplant patients with multiple myeloma.3 In this trial, both the response rates and a marker for osteoblast activation (ie, alkaline phosphatase) were superior in the group of patients receiving bortezomib-based therapy compared with those receiving the MP regimen alone.

So far, the role of bortezomib in bone disease has not been demonstrated in patients in the transplant or relapsed setting. However, the ability to see long-term survival, with a follow-up period of 5 years, is particularly exciting in a condition that is without a cure. At 5 years mortality was reduced substantially, by more than 30%, in this patient population compared with the conventional first-line therapy with MP. These datawill help to continually shape appropriate guideline/protocol development.

References

  1. Cavo M, Rajkumar SV, Palumbo A, et al. Inter na – tional Myeloma Working Group. International Myeloma Work ing Group consensus approach to the treatment of multiple myeloma patients who are candidates for autologous stem cell transplantation. Blood. 2011;117:6063-6073.
  2. Ludwig H, Beksac M, Bladé J, et al. Multiple myeloma treatment strategies with novel agents in 2011: a European perspective. Oncologist. 2011;16:388-403.
  3. Delforge M, Terpos E, Richardson PG, et al. Fewer bone disease events, improvements in bone remodeling, and evidence of bone healing with bortezomib plus melphalan-prednisone vs melphalan-prednisone in the phase III VISTA trial in multiple myeloma. Eur J Haematol. 2011;86:372-384.