European Journal of Biomedical and Pharmaceutical Sciences

FOUR-DRUG REGIMENS FOR TREATMENT OF MULTIPLE MYELOMA: A SYSTEMATIC REVIEW ON THEIR EFFICACY AND SAFETY

Ukasha Habib*, Iyanu Victoria Olateju, Azka Ali, Raysha Farah, Osazee Eguagie, Chipo Makoni, Ofure Harrison, Jose Antonio Gomez Miranda, Farzan Salehi, Samia Jahan, Dolly Ogwu, Matthew Oluwafemi Owolabi, Okoma Shed Akolokwu, Lisandra Vega, Nikitha Chellapuram and Roland Oluwapelumi Ojo

ABSTRACT

Introduction: Despite multiple treatment options available for the treatment of Multiple myeloma (MM), the disease remains incurable and disease relapse ultimately occurs after a period of disease control. Our review aims to measure the efficacy and safety of four-drug regimens in terms of progression-free survival and disease responses. Methods: A comprehensive literature search yielded a total of 36429 articles. Our search strategy included the following MeSH terms: “multiple myeloma” and “antineoplastic agents”. Ten studies met the inclusion criteria: phase I/II trials, phase III trials, studies published after 2010, and use of four-drug regimens with clear documentation of outcomes such as overall response rates (ORR), progression-free survival (PFS), and overall survival (OS). Results: A total of ten studies with 2,416 patients were included. 2,275 patients had relapsed refractory MM (RRMM), and 141 patients had newly diagnosed MM (NDMM). Seven studies demonstrated a comparison between three-drug and four-drug regimens. Six studies reported four-drug regimens to be significantly superior to three-drug regimens in terms of ORR. Two of the three studies that did not make any such comparison, showed an ORR of more than 90% with four-drug regimens whereas one study reported an ORR of about 67%. Other parameters such as PFS and OS also showed the four-drug regimen as an effective MM strategy. Conclusion: Four-drug antineoplastic regimens significantly improve the responses in both newly diagnosed and relapsed/refractory multiple myeloma. However, data on survival is awaited. The cost and associated synergism in the toxicity profile need further analysis and follow-up.

Keywords: “multiple myeloma” and “antineoplastic agents”.