Bolus vincristine and epirubicin with cyclophosphamide and dexamethasone (VECD) as induction and salvage treatment in multiple myeloma

Abstract

The VAD regimen (infusional vincristine, doxorubicin and intermittent high-dose dexamethasone) is widely considered the standard salvage chemotherapy for multiple myeloma resistant to alkylating agents and is increasingly used for induction in previously untreated patients prior to high-dose chemotherapy. We investigated the VECD protocol, a VAD-based regimen using bolus injections of vincristine 1.5 mg day 1 and epirubicin 20 mg/m 2 days 2 and 3 with 1 h infusions of cyclophosphamide 200 mg/m 2 days 1-3 and oral dexamethasone 20 mg/m 2 days 1-5 as induction and salvage treatment in multiple myeloma. Fifteen previously untreated and 25 patients with relapsed or refractory myeloma were included. Cycles were repeated every 3 weeks. In the group of previously untreated patients the response rate was 53% and the median survival has not been reached at 59 months. For relapsed and refractory patients the response rate was 44% and the median survival 13 months. In the group of patients with truly refractory disease on prior chemotherapy a response rate of 47% was achieved, which appears superior to the results observed for VAD alone. The main toxicities were leukocytopenia WHO grade IV and infections grade III/IV with both toxicities being significantly more pronounced in pretreated patients. VECD appears to be an effective regimen for induction and salvage therapy in multiple myeloma. Based on the limited number of patients treated the results are comparable to those reported for VAD, with the advantage that the infusional application of vincristine and the anthracycline is omitted.

Thalidomide in combination with vincristine, epirubicin and dexamethasone (VED) for previously untreated patients with multiple myeloma

“…Epirubicin was used instead of doxorubicin to reduce cardiotoxicity (26). VECD was found to be well tolerated and the response rate achieved with this regimen appeared to be comparable with that achieved with VAD (25). In the present study, however, we omitted cyclophosphamide in VECD to allow more reliable comparisons with the results of studies using VAD or VAD‐like regimens.…”

“…Others have administered vincristine and doxorubicin by rapid intravenous infusion for four consecutive days and have reported a response rate of 67% in previously untreated patients (21), which is comparable with that achieved with VAD (18, 20, 22–24). In our institution, we developed a regimen consisting of vincristine, epirubicin, cyclophosphamide and dexamethasone (VECD) (25), in which vincristine and epirubicin were given as bolus injections and not as continuous infusion. Epirubicin was used instead of doxorubicin to reduce cardiotoxicity (26).…”

OPP-EBV-CAD Regimen as Salvage Treatment in Advanced Refractory or Resistant Multiple Myeloma

“…Better therapeutic results have often been achieved in populations with a substantial number of primary resistant patients [16,27,28] (Table III), and this is probably due to the development of more resistant and proliferative subclones in patients with relapsed refractory disease [35]. These observations are particularly relevant when evaluating the good results obtained with the VAMP, TDC and VECD regimens [21,26,30] (Table 111): high percentages of primary resistant cases, few patients previously treated with anthracyclines, some patients without a large tumor mass. Moreover, in the case of the VAMP protocol [21], it should be noted that the patients were not heavily pretreated (only 4/45 cases received three or more treatments, and 25/45 only one), and there was an inclusion bias in favour of less advanced and probably more responsive cases.…”

“…Moreover, VAD has proved to be quite useful in primary resistant cases [17]. Several other regimens [18][19][20][21][22][23][24][25][26][27][28][29][30] (Table 111) have been evaluated in these clinical situations with the aim of improving the results attained with VAD, reducing the risk of VAD-related infections and simplifying drug administration procedures.…”

Fuzheng Qingjie granules potentiate the anticancer effect of cyclophosphamide by regulating cellular immune function and inducing apoptosis in Hepatoma 22 tumor-bearing mice

“…CTX is used in combination with other antineoplastic drugs to treat a variety of susceptible malignancies, including lymphoma (15) and myeloma (16), ovarian (17), nasopharyngeal (18) and liver cancer (19). However, CTX is also associated with severe toxicities, including diarrhea, nausea, vomiting, bone marrow suppression, haemorrhagic cystitis, fatigue, night sweat, hair loss, immunosuppression and impaired hepatic and renal function (20).…”