Subcutaneous bortezomib might be standard of care for patients with multiple myeloma: a systematic review and meta-analysis

Background: Administration of subcutaneous (SC) bortezomib in patients with multiple myeloma (MM) has increased in recent years. Yet, it is unclear whether there is sufficient evidence to support the use of SC bortezomib as a standard of care. Methods: A systematic review of 4 randomized controlled trials and 8 retrospective trials comparing SC to intravenous (IV) bortezomib among 1,857 MM patients was performed. Embase, PubMed, Clinical Trials.gov, Cochrane Library and reference lists were searched for relevant studies from inception until August 2018. Outcomes of interest included 1-year overall survival (OS), 1-year progression-free survival (PFS), objective response rate (ORR) and adverse events (AEs). Random events meta-analyses were performed. We also performed sensitivity analysis to examine whether the results of the meta-analysis were robust. Results: Compared to IV administration, SC bortezomib had a significantly lower incidence of some all-grade or grade 3–4 AE, such as peripheral sensory neuropathy, leukopenia and thrombocytopenia (p<0.05). There was no statistical difference in 1-year OS, 1-year PFS, ORR between SC and IV bortezomib (p>0.05). Conclusion: The data presented so far consistently show that SC bortezomib has become a standard of care for patients with MM.