Revised Panobinostat Combination Shows Efficacy in Multiple Myeloma

Andrew Spencer, MD, MBBS, head of the Malignant Haematology and Stem Cell Transplantation Service at The Alfred Hospital, professor of Hematology at Monash University, head of the Myeloma Research Group and codirector of the ACRF Blood Cancer Therapeutics Centre at the Australian Centre for Blood Diseases, discusses the PANORAMA 3 trial data (NCT01023308) of oral panobinostat (Farydak) plus subcutaneous bortezomib (Velcade) and dexamethasone versus placebo, bortezomib, and dexamethasone.

The primary end point was overall response rate after 8 cycles. The higher dose of panobinostat was associated with a high response rate; those receiving the 20-mg dose of panobinostat had a higher response rate. Spencer says it is important to remember that almost three quarters of these patients had been exposed to prior proteasome inhibitors (PIs), making this treatment more like retreatment, adding panobinostat to a PI. The continued administration of panobinostat led to deeper responses in patients.

An important observation from this study was the evaluation of the gastrointestinal (GI) toxicity, according to Spencer. All 3 arms had less GI toxicity than had been observed in the prior study with intravenous bortezomib in combination with panobinostat and dexamethasone. There was minimal grade 3/4 diarrhea and vomiting, showing this regimen has a more manageable toxicity profile.

The last important takeaway is that this regimen is more deliverable. Spencer feels that because this activity was seen in adverse biology myeloma, this combination is worth revisiting.