Article type
Abstract
"Background: In the scenario of frequent innovations, new therapeutic alternatives to treat patients with Multiple Myeloma (MM) require continuous updating of clinical practice guidelines (CPG) based on the best available evidence. In Brazil, the process of updating considered the evidence available in four CPG.
Objective: To compare antineoplastics recommended for the treatment of patients with early-stage MM eligible for autologous stem cell transplant (ASCT) in different guidelines.
Method: Data was collected from the CPG elaborated by: National Comprehensive Cancer Network (NCCN); European Society for Medical Oncology (ESMO); Brazilian Hematology Association; Hemotherapy and Cellular Therapy (ABHH); and National Committee for Health Technology Incorporation (CONITEC).
Results: Regarding drug treatment for the initial disease, ESMO and CONITEC documents comprise 4 phases (induction, conditioning, consolidation and maintenance); ABHH has 3 phases (induction, consolidation and maintenance); and the NCCN only has 2 phases (induction and maintenance). In general, 3 to 4 drugs are recommended for induction, including at least one proteasome inhibitor (bortezomib, carfilzomib or ixazomib), an immunomodulator (lenalidomide or thalidomide) and a corticosteroid (dexamethasone or prednisone). Melphalan is recommended in all guidelines that have a conditioning phase. In maintenance, with the exception of the CONITEC guideline that recommends the use of thalidomide, all documents include regimens with lenalidomide and bortezomib. Also in maintenance, NCCN includes as additional alternatives daratumumab, ixazomib and carfilzomib.
Conclusions: There is a variation in the therapeutic regimen recommended by the guidelines, regarding the number of phases and availability of chemotherapy drugs. Although conditioning and consolidation aim to reduce residual tumor burden, improve treatment response and overall survival, in general only the induction and maintenance phases are well established in the guidelines investigated. The NCC guideline recommends more therapeutic options and only CONITEC CPG does not recommends a proteasome inhibitor in the maintenance phase."
Objective: To compare antineoplastics recommended for the treatment of patients with early-stage MM eligible for autologous stem cell transplant (ASCT) in different guidelines.
Method: Data was collected from the CPG elaborated by: National Comprehensive Cancer Network (NCCN); European Society for Medical Oncology (ESMO); Brazilian Hematology Association; Hemotherapy and Cellular Therapy (ABHH); and National Committee for Health Technology Incorporation (CONITEC).
Results: Regarding drug treatment for the initial disease, ESMO and CONITEC documents comprise 4 phases (induction, conditioning, consolidation and maintenance); ABHH has 3 phases (induction, consolidation and maintenance); and the NCCN only has 2 phases (induction and maintenance). In general, 3 to 4 drugs are recommended for induction, including at least one proteasome inhibitor (bortezomib, carfilzomib or ixazomib), an immunomodulator (lenalidomide or thalidomide) and a corticosteroid (dexamethasone or prednisone). Melphalan is recommended in all guidelines that have a conditioning phase. In maintenance, with the exception of the CONITEC guideline that recommends the use of thalidomide, all documents include regimens with lenalidomide and bortezomib. Also in maintenance, NCCN includes as additional alternatives daratumumab, ixazomib and carfilzomib.
Conclusions: There is a variation in the therapeutic regimen recommended by the guidelines, regarding the number of phases and availability of chemotherapy drugs. Although conditioning and consolidation aim to reduce residual tumor burden, improve treatment response and overall survival, in general only the induction and maintenance phases are well established in the guidelines investigated. The NCC guideline recommends more therapeutic options and only CONITEC CPG does not recommends a proteasome inhibitor in the maintenance phase."