Modified HyperCVAD Versus Bortezomib-HyperCAD in Patients With Relapsed/Refractory Multiple Myeloma.

INTRODUCTION: Multiple myeloma (MM) is an incurable plasma cell malignancy, in which aggressive relapses might require salvage cytotoxic infusional chemotherapy. Several clinical trials that reported the efficacy of bortezomib led to institutional practice changes in which vincristine was replaced with bortezomib in the modified hyperCVAD regimen, creating a new treatment regimen, named "bortezomib-hyperCAD." PATIENTS AND METHODS: We retrospectively describe the effectiveness and tolerability of 2 chemotherapy regimens among 33 patients with relapsed and/or refractory MM. Patients who received ≥ 1 cycle of modified hyperCVAD or bortezomib-hyperCAD between 2011 and 2015 were assessed. RESULTS: The median number of cycles administered in each arm was 2. The overall response rate was 40% (6 partial responses) in the modified hyperCVAD group and 44.4% (1 complete response, 1 very good partial response, and 6 partial responses) in the bortezomib-hyperCAD group (Fisher exact P = .80). Median progression-free survival (PFS) and median overall survival (OS) for patients in the modified hyperCVAD group was 6.3 months and 11.1 months, respectively. This was comparable with patients in the bortezomib-hyperCAD group, who had a median PFS of 6.6 months and a median OS of 13.8 months (log rank P = .54 and .66, respectively). There was no statistically significant association between treatment arm and febrile neutropenia, emergency department visits, hospitalizations, or peripheral neuropathy (all Fisher exact P values > .05). CONCLUSION: Overall effectiveness and tolerability outcomes were similar between modified hyperCVAD and bortezomib-hyperCAD, with both regimens showing an impressive response rate among refractory and heavily pretreated patients with relapsed MM.

Medication adherence: pharmacist perspective.

OBJECTIVE: To provide pharmacists with a current, comprehensive review of medication adherence challenges and solutions. DATA SOURCES: A computerized search of the PubMed and Medline databases (through July 2008) identified English language review articles on medication adherence using the MeSH terms patient compliance or adherence and medication, drug regimen, or treatment. STUDY SELECTION: By the authors. DATA EXTRACTION: The results were filtered to include those published in pharmacy journals, and 117 publications were selected based on the content of their abstracts. The final version of this review article used 55 of the 117 publications. An additional 15 publications that provided examples of specific adherence issues were included. A vignette from the authors' experience was used as a case study. DATA SYNTHESIS: This article introduces the challenge of patient medication adherence, discusses the various methods by which to monitor medication adherence, describes various treatment- and condition-related barriers to adherence, and discusses the effectiveness of numerous adherence intervention strategies. CONCLUSION: Nonadherence to a medication regimen may have multiple underlying causes, some of which may be easier to address than others. Open discussion between the pharmacist and patient regarding barriers to adequate medication adherence, followed by a multifaceted, personalized intervention to address these barriers, plays a key role in encouraging patients to adhere to the recommendations of the health care team.