Dr. Jagannath Discusses the VANTAGE Trials

Sundar Jagannath, MD, director of the Multiple Myeloma Program at the Tisch Cancer Institute at Mount Sinai Medical Center in New York City, discusses the VANTAGE 095 and 088 trials, which combined vorinostat and bortezomib in slightly different patient populations. The goal was to find new treatment approaches for patients with relapsed or refractory multiple myeloma.

The VANTAGE 095 phase IIb trial investigated patients that had failed all prior therapies. In this study the combination was effective. The progression-free survival (PFS) was 3.1 and overall survival was 11.2 months.

The phase III VANTAGE 088 trial included patients that had relapsed but were not refractory to bortezomib. The addition of vorinostat to bortezomib, when compared to bortezomib alone, produced a 1.2-month increase in PFS (HR, 0.77).

The addition of vorinostat to bortezomib resulted in a marked increase in gastrointestinal toxicity and thrombocytopenia. As a result of this added toxicity approximately 50% of patients withdrew from the study. Jagannath feels these side effects could have been avoided with dose modifications. Patients on the trial received vorinostat at 40 mg/day for 14 days, plus the standard 21-day cycle of bortezomib.

Jagannath mentions that outside of the VANTAGE trials the combination of vorinostat and lenalidomide has also been shown to be very effective. The results from this trial have not yet been released but may represent more options for relapsed/refractory multiple myeloma patients.