VELCADE® (bortezomib) demonstrated efficacy in a large (N=155) prospective study in patients with relapsed mantle cell lymphoma (MCL)
VELCADE (bortezomib) Delivered High Overall Response Rates, Including CRs
- Median time to first response was 40 days
- The most commonly reported grade ≥3 adverse reactions in patients with relapsed mantle cell lymphoma (N=155) were peripheral neuropathy NEC (12%), fatigue (10%), thrombocytopenia (8%), and diarrhea NOS (7%)
CRs Resulted in More Durable Responses
- Results demonstrated delayed onset of disease progression in responding patients, especially those achieving CR2
- The most commonly reported serious adverse reactions were nausea, vomiting NOS, abdominal pain NOS, and syncope (3% each); pyrexia, pneumonia NOS, and sepsis NOS (2% each)3
Time at Which Responding Patients Achieve Minimum Disease Burden4
A subset analysis was performed on the 48 VELCADE (bortezomib) patients with CR and PR. This graph shows the time to the minimum disease burden (defined as minimum sum of products of longest perpendicular dimension of all measurable lesions by proportion of patients) in responding patients.
- Per protocol, patients received up to 51 weeks of therapy5
- Responding patients achieved their best response after longer duration of therapy (n=48)4
- 64% of patients continued to improve their response after 12 weeks
- 74% of patients achieved minimum disease burden by 24 weeks
- 23% of patients discontinued
VELCADE (bortezomib)due to treatment-related adverse reactions6
Indications and Important Safety Information for VELCADE® (bortezomib)
INDICATIONS: VELCADE (bortezomib) is indicated for the treatment of patients with multiple myeloma. VELCADE is indicated for the treatment of patients with mantle cell lymphoma who have received at least 1 prior therapy.
CONTRAINDICATIONS: VELCADE is contraindicated in patients with hypersensitivity (not including local reactions) to bortezomib, boron, or mannitol, including anaphylactic reactions. VELCADE is contraindicated for intrathecal administration.
WARNINGS AND PRECAUTIONS
VELCADE (bortezomib) is for subcutaneous or IV administration only. Because each route of administration has a different reconstituted concentration, caution should be used when calculating the volume to be administered.
Peripheral neuropathy, including severe cases, may occur. Patients should be monitored for symptoms and managed with dose modification or discontinuation. Patients with preexisting symptoms may experience worsening peripheral neuropathy (including≥grade 3). Starting with VELCADE subcutaneously may be considered for patients who either have preexisting or are at high risk for peripheral neuropathy.
Hypotension: Caution should be used when treating patients receiving antihypertensives, those with a history of syncope, and those who are dehydrated.
Cardiac toxicity, including acute development or exacerbation of congestive heart failure and new onset of decreased left ventricular ejection fraction, has occurred. Isolated cases of QT-interval prolongation have been reported. Patients with risk factors for, or existing, heart disease should be closely monitored.
Pulmonary toxicity: Acute respiratory distress syndrome (ARDS) and acute diffuse infiltrative pulmonary disease of unknown etiology have occurred (sometimes fatal). Pulmonary hypertension, in the absence of left heart failure or significant pulmonary disease, has been reported. In the event of new or worsening cardiopulmonary symptoms, consider interrupting VELCADE until a prompt and comprehensive diagnostic evaluation is conducted.
Posterior reversible encephalopathy syndrome has occurred. Consider MRI imaging for onset of visual or neurological symptoms; discontinue VELCADE if suspected.
Gastrointestinal toxicity, including nausea, diarrhea, constipation, and vomiting, has occurred and may require use of antiemetic and antidiarrheal medications or fluid replacement. Interrupt VELCADE (bortezomib) for severe symptoms.
Thrombocytopenia/Neutropenia: Manage with dose and/or schedule modifications. Complete blood counts should be monitored frequently during treatment. There have been reports of gastrointestinal and intracerebral hemorrhage. Transfusions may be considered.
Tumor lysis syndrome: Closely monitor patients with high tumor burden and take appropriate precautions.
Hepatic toxicity: Monitor hepatic enzymes during treatment. Upon occurrence, interrupt therapy with VELCADE to assess reversibility.
Embryo-fetal risk: Women should avoid breast-feeding or becoming pregnant while on VELCADE.
Patients with diabetes may require close monitoring and adjustment of the antidiabetic medications.
DRUG INTERACTIONS: Closely monitor patients receiving VELCADE (bortezomib) in combination with strong CYP3A4 inhibitors. Avoid concomitant use of strong CYP3A4 inducers.
Previously untreated multiple myeloma (MM): In the phase 3 study of VELCADE administered intravenously with melphalan and prednisone (MP) vs MP alone, the most commonly reported adverse reactions (ARs) were thrombocytopenia (48% vs 42%), neutropenia (47% vs 42%), peripheral neuropathy (46% vs 1%), nausea (39% vs 21%), diarrhea (35% vs 6%), neuralgia (34% vs <1%), anemia (32% vs 46%), and leukopenia (32% vs 28%).
Relapsed MM and mantle cell lymphoma: In the integrated analysis of 1163 patients in phase 2 and 3 studies of VELCADE (bortezomib) administered intravenously, the most commonly reported ARs were nausea (49%), diarrhea NOS (46%), fatigue (41%), peripheral neuropathy NEC (38%), and thrombocytopenia (32%). A total of 26% of patients experienced serious ARs. The most commonly reported serious ARs included diarrhea, vomiting, and pyrexia (each 3%); nausea, dehydration, and thrombocytopenia (each 2%); and pneumonia, dyspnea, peripheral neuropathies NEC, and herpes zoster (each 1%).
Relapsed MM subcutaneous vs IV: In the phase 3 study of VELCADE administered subcutaneously vs intravenously in relapsed MM, safety data were similar between the two treatment groups. The most commonly reported ARs in the subcutaneous vs IV treatment groups were peripheral neuropathy (37% vs 50%) and thrombocytopenia (30% vs 34%). The incidence of serious ARs was similar in the subcutaneous treatment group (20%) and the IV treatment group (19%). The most commonly reported serious ARs were pneumonia and pyrexia (each 2%) in the subcutaneous treatment group and pneumonia, diarrhea, and peripheral sensory neuropathy (each 3%) in the IV treatment group.
- Please see full Prescribing Information available at www.VELCADE.com
†Response rates to VELCADE (bortezomib) were determined according to International Workshop Response Criteria (IWRC)1 based on independent radiologic review of CT scans.
‡PINNACLE TRIAL: a single-arm, multicenter, phase 2, open-label trial (N=155) evaluating the efficacy and safety of VELCADE (bortezomib) in patients with mantle cell lymphoma who had received at least 1 prior therapy. Primary endpoint was TTP and secondary endpoints were ORR, CR, DOR, and overall survival. As an appropriate cohort of historical controls could not be found for comparison to the results of this study, the formal statistical comparisons of TTP and survival specified in the protocol could not be performed.
References: 1. Cheson BD, Horning SJ, Coiffier B, et al. Report of an international workshop to standardize response criteria for non-Hodgkin's lymphomas. J Clin Oncol. 1999;17(4):1244-1253. 2. Fisher RI, Bernstein SH, Kahl BS, et al. Multicenter phase II study of bortezomib in patients with relapsed or refractory mantle cell lymphoma. J Clin Oncol. 2006;24(30):4867-4874. 3. Data on file 51, Millennium Pharmaceuticals, Inc. 4. Data on file 28, Millennium Pharmaceuticals, Inc. 5. Data on file 37, Millennium Pharmaceuticals, Inc. 6. Data on file 55, Millennium Pharmaceuticals, Inc.