Is DCEP Chemotherapy a Viable Bridge to Definitive Therapy in Resistant Myeloma?
Posted: Thursday, April 26, 2018
Cycles of dexamethasone, cyclophosphamide, etoposide, and cisplatin (DCEP) chemotherapy may stall progress of relapsed and/or refractory multiple myeloma in some patients. However, in the absence of definitive therapy, the value of this strategy is questionable, according to Andrew Spencer, MD, of the Australian Centre for Blood Diseases, Monash University, Melbourne, Australia, and colleagues, who reported their findings in Leukemia & Lymphoma.
“The role of DCEP should be for bridging to more definitive therapy such as [autologous stem cell transplantation], novel therapies, or enrollment in a clinical trial,” the authors indicated.
In this retrospective, nonrandomized study, results from 62 patients who received DCEP between 2005 and 2017 were analyzed. The overall response rate to DCEP was 55%, and the median overall survival was 9.6 months. Furthermore, the median overall survival of patients bridged to autologous stem cell transplantation was 32.8 months, which represents a significant improvement over the 10.7-month median overall survival in patients not bridged to autologous stem cell transplantation (P = .0004).
DCEP treatment was associated with significant mortality, at 9.7%. Grade 3 hematologic toxicities included neutropenia, anemia, and thrombocytopenia in 70.3%, 45.0%, and 43.2% of cycles, respectively. In this study, progression-free survival was limited to 2 months, and the authors concede DCEP is not a treatment expected to provide long-term benefit. Rather, this strategy should be employed as a multiple myeloma management tool on a targeted, short-term basis.