Canterbury DHB

Context

Key Points

Bortezomib is rapidly becoming the drug of choice internationally for myeloma. In New Zealand it is approved for use first line or second line in myeloma. Bortezomib has shown an overall survival advantage when used in first line therapy in the elderly in the VISTA trial (Dimopoulos et al, 2009) and gives rapid response rates when used as part of an induction combination for younger patients.

Thalidomide (when combined with melphalan and prednisone) has also shown a survival advantage when used first line for myeloma in those not eligible for auto SCT (Hulin et al, 2009). Thalidomide is also funded by PHARMAC for first line and all subsequent lines of therapy.

Lenalidomide is approved for use as second or third line therapy in myeloma and is now funded by PHARMAC. Special authority for subsidy can be obtained for treatment of relapsed / refractory myeloma with progressive disease, either as third line treatment or as second line in patients who have experienced severe (grade ≥3), dose-limiting, peripheral neuropathy with bortezomib / thalidomide that precludes further treatment with either of these agents.

Pamidronate 30 mg IV once per month for 2 years is the standard bisphosphonate for patients with myeloma who have documented bony disease or hypercalcaemia.

Clinical trials may allow access to newer agents and enrolment in available clinical trials is recommended

The treatment of specific complications of myeloma will include:

Urgent therapy could include intensive intravenous cyclophosphamide 1 g/m2 plus dexamethasone 40 mg daily for 4 days (or until improved) plus bortezomib 1.5 mg/m2 subcut day 1,4,8,11 for a first 3 week cycle.

About this Canterbury DHB document (7589):

Document Owner:

Sean Macpherson (see Who's Who)

Issue Date:

September 2014

Next Review:

September 2016

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 7589