Bortezomib, Vorinostat, And Dexamethasone Combination Therapy In Relapsed Myeloma: Results Of The Phase 2 Muk Four Trial

In this phase 2 multicenter trial, vorinostat in combination with bortezomib and dexamethasone demonstrated good response in relapsed multiple myeloma; however, it was not very well tolerated. There is ongoing rationale for further optimization of histone deacetylase inhibitor based combinations in the treatment of myeloma to improve tolerability and enhance efficacy.Introduction: Outcomes continue to improve in relapsed myeloma as more effective treatment options emerge. We report a multicenter single-arm phase 2 trial evaluating toxicity and efficacy of the histone deacetylase (HDAC) inhibitor vorinostat in combination with bortezomib and dexamethasone. Patients and Methods: Sixteen patients who had received a median of 1 prior treatment line received bortezomib subcutaneously 1.3 mg/m(2) days 1, 4, 8, and 11; dexamethasone 20 mg orally days 1-2, 4-5, 8-9, and 11-12; vorinostat 400 mg orally days 1-4, 8-11, and 15-18 of a 21-day cycle. After receipt of a minimum of 3 cycles of therapy, participants received maintenance vorinostat (400 mg days 1-4 and 15-18 of a 28-day cycle). Results: Overall response was 81.3%: complete response occurred in 4 of 16, very good partial response in 2 of 16, and partial response 7 of 16. Clinical benefit response rate was 100%; median progression-free survival was 11.9 months. A total of 75% patients experienced a dose reduction or stopped treatment as a result of intolerability. Conclusion: Although toxicity and dose reductions were observed, this study demonstrates that the combination of vorinostat, bortezomib, and dexamethasone is effective in relapsed myeloma with good response rates, suggesting there is an ongoing rationale for further optimization of HDAC inhibitor-based combinations in the treatment of myeloma to improve tolerability and enhance efficacy. (C) 2020 Elsevier Inc. All rights reserved.