Analysis of the VCD protocol (bortezomib, cyclophosphamide, and dexamethasone) in the treatment of multiple myeloma

Authors

DOI:

https://doi.org/10.33448/rsd-v12i13.44144

Keywords:

Multiple myeloma; Bortezomib; Cyclophosphamide; Dexamethasone; Brazilian unified health system.

Abstract

Multiple myeloma (MM) is an incurable cancer that affects plasma cells and represents the second most common type of blood cancer. Risk factors, such as exposure to substances like benzene, pesticides, and radiation, have been associated with the development of MM. In 2020, the World Health Organization recorded 176,404 new cases of MM worldwide, with 117,077 deaths related to the disease. In Brazil, approximately 2,600 cases were diagnosed between 2013 and 2019. The diagnosis of MM is based on the presence of monoclonal immunoglobulins, abnormal plasma cells in the bone marrow, and damage to target organs. The treatment of multiple myeloma is complex and often involves a combination of approaches, including chemotherapy, immunotherapy, radiotherapy, and, in certain cases, hematopoietic stem cell transplantation. Induction therapy with Bortezomib, cyclophosphamide, and dexamethasone (VCD) is often used and has shown rapid and effective results. It is worth noting that VCD is supplied free of charge within the Unified Health System (SUS). Bortezomib, a proteasome inhibitor, is an essential part of the treatment but was included in the National Commission for the Incorporation of Technologies in SUS (CONITEC) only in 2021, unlike the other components that have been part of the National List of Essential Medicines (Rename) since its first edition in 2001. This literature review aims to deepen the complexity and effectiveness of VCD therapy in the treatment of MM provided by SUS. The treatment of multiple myeloma is multifaceted, aiming to control the disease, alleviate symptoms, improve the quality of life, and extend the survival of patients, representing a significant challenge in the field of oncology.

References

Alves, M. B. (2017). Mieloma múltiplo: diagnóstico e terapêutica: presente e futuro [Monografia de Mestrado Integrado em Ciências Farmacêuticas]. Universidade de Lisboa, Faculdade de Farmácia. https://repositorio.ul.pt/handle/10451/36073

ANVISA - Agência Nacional de Vigilância Sanitária. (s.d.). Bulário Eletrônico: Bortezomibe. https://consultas.anvisa.gov.br/#/bulario/q/?nomeProduto=BORTEZOMIBE

Bergsagel, D. E. (1989). Is aggressive chemotherapy more effective in the treatment of plasma cell myeloma? European Journal of Cancer & Clinical Oncology, 25(2), 159-161. https://doi.org/10.1016/0277-5379(89)90001-1

Brasil. Ministério da Saúde. (2022). Diretrizes Diagnósticas e Terapêuticas do Mieloma Múltiplo. Conitec. Secretaria de Ciência, Tecnologia, Inovação e Insumos Estratégicos em Saúde. Departamento de Gestão e Incorporação de Tecnologias e Inovação em Saúde. https://www.gov.br/conitec/pt-br/midias/consultas/relatorios/2022/20220526_ddt_mieloma_multiplo_cp.pdf

Brasil. Ministério da Saúde. (2014). Diretrizes Metodológicas. Sistema GRADE – Manual de Graduação da Qualidade da Evidência e Força de Recomendação para Tomada de Decisão em Saúde. https://bvsms.saude.gov.br/bvs/publicacoes/diretrizes_metodologicas_sistema_grade.pdf

Brasil. Ministério da Saúde. (2020). Portaria SCTIE/MS Nº 43, de 25 de setembro de 2020. https://bvsms.saude.gov.br/bvs/saudelegis/sctie/2020/prt0043_28_09_2020.html

Brasil. Ministério da Saúde. (2022). Relação Nacional de Medicamentos Essenciais. https://www.gov.br/saude/pt-br/composicao/sectics/daf/relacao-nacional-de-medicamentos-essenciais

Carvalho, B. R. V. (2015). Protocolos de Tratamento de Doenças Hematológicas: Mieloma Múltiplo. https://www.hemope.pe.gov.br/pdf/mieloma-m-ltiplo.pdf

Cowan, A. J., Green, D. J., Kwok, M., Lee, S., Coffey, D. G., Homberg, L. A., Tuazon, S., Gopal, A. K., & Libby, E. N. (2022). Diagnosis and management of multiple myeloma: a review. https://doi.org/10.1001/jama.2022.0003

Durak, B. A., Akay, O. M., Sungar, G., Bademci, G., Aslan, V., Caferler, J., Ozdemir, M., Cilingir, O., Artan, S., & Gülbas, Z. (2011). Conventional and molecular cytogenetic analyses in Turkish patients with multiple myeloma. Turkish Journal of Hematology, 28(3), 1-9. https://doi.org /10.5152/tjh.2011.42

Gonçalves, M. J. P., Filho, R. S. V., & Peçanha, M. A. P. (2023). Conhecendo o Mieloma Múltiplo: uma revisão de literatura. Revista Científica da Faculdade de Medicina de Campos, 18(1), 38-43. https://doi.org/10.29184/1980-7813.rcfmc.696.vol.18.n1.2023

Gole, L., Lin, A., Chua, C., & Chng, W. J. (2014). Modified cIg-FISH protocol for multiple myeloma in routine cytogenetic laboratory practice. Cancer Genetics, 207(1-2), 31-34. https://doi.org /10.1016/j.cancergen.2013.12.001

Grade Guidance Group. (2022). Grading of Recommendations Assessment, Development, and Evaluation. https://www.gradeworkinggroup.org/#

Higgins, J. P. T., Savović, J., Page, M. J., Elbers, R. G., & Sterne, J. A. C., (2021). Assessing risk of bias in a randomized trial. In: Higgins, J., et al. (Eds.), Cochrane Handbook for Systematic Reviews of Interventions, version 6.2 (Cap. 8, pp. 205-228).

Hungria, V. T. M. (2007). Tratamento do Mieloma Múltiplo recidivado. Revista Brasileira de Hematologia e Hemoterapia, 29(1), 48–53. https://doi.org/10.1590/S1516-84842007000100011

International Myeloma Foundation Latin America. (s.d.). Bortezomibe. https://myeloma.org.br/bortezomibe/

Joseph, N. S., Kaufman, J. L., Dhodapkar, M. V., Hofmeister, C. C., Almaula, D. K., Heffner, L. T., Gupta, V. A., Boise, L. H., Lonial, S., & Nooka, A. K. (2020). Long-term follow-up results of lenalidomide, bortezomib, and dexamethasone induction therapy and risk-adapted maintenance approach in newly diagnosed multiple myeloma. Journal of Clinical Oncology, 38(17), 1928-1937. https://doi.org/10.1200/JCO.19.02515

Katzung, B. G., Masters, S. B., & Trevor, A. J. (2012). Basic and Clinical Pharmacology (12th ed.). The McGraw-Hill Companies, Inc. ISBN 978-0-07-176401-8. https://pharmacomedicale.org/images/cnpm/CNPM_2016/katzung-pharmacology.pdf

Mota, T. (2022). Já ouviu falar em mieloma múltiplo refratário e recidivado? Revista Abrale On-line. https://revista.abrale.org.br/saude/2022/03/ja-ouviu-falar-em-mieloma-multiplo-recidivado-e-refratario/

Rother, E. T. (2007). Revisão sistemática x revisão narrativa. Acta paul. Enferm.

Sandy Jr., P. A., Carvalho, H. J., Rabelo, I. B., & Velano, C. E. E. (2015). Mieloma Múltiplo aos 30 anos: o avesso da epidemiologia. Revista da Sociedade Brasileira de Clínica Médica, 13(3), 210-212. https://www.sbcm.org.br/ojs3/index.php/rsbcm/article/download/155/151/

Shea, B. J., Reeves, B. C., Wells, G., Thuku, M., Hamel, C., Moran, J., Moher, D., Tugwell, P., Welch, V., Kristjansson, E., & Henry, D., A. (2017). AMSTAR 2: A critical appraisal tool for systematic reviews that include randomized or non-randomized studies of healthcare interventions, or both. BMJ, 358: j4008. https://doi.org/10.1136/bmj.j4008

Sucro, L. V., Silva, J. C. M. L., Gehlen, G. W., Eldin, J. F. S., Amaral, G. A., & Santana, M. A. P. (2009). Mieloma Múltiplo: Diagnóstico e Tratamento. Revista Médica de Minas Gerais, 19(1), 58-62. https://rmmg.org/exportar-pdf/490/v19n1a10.pdf

Torres, R. C., Insuela, D. B. R., & Carvalho, V. F. (2012). Mecanismos Celulares e Moleculares da Ação Anti-inflamatória dos Glicocorticoides. Corpus et Sciencia, 8(2), 36-51. https://www.arca.fiocruz.br/handle/icict/18370

Whiting, P. F., Rutjes, A. W. S., Westwood, M. E., Mallett, S., Deeks, J. J., Reitsma, J. B., Leeflang, M. M. G., Sterne, J. A. C., & Bossuyt, P. M. M. (2011). QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Annals of Internal Medicine, 155(8), 529-536. https://doi.org/10.7326/0003-4819-155-8-201110180-00009

Published

28/11/2023

How to Cite

COSTA, F. B. da .; BALOGH JUNIOR, J.; VIEIRA, L. A. .; GIORGETTI, L. Analysis of the VCD protocol (bortezomib, cyclophosphamide, and dexamethasone) in the treatment of multiple myeloma. Research, Society and Development, [S. l.], v. 12, n. 13, p. e42121344144, 2023. DOI: 10.33448/rsd-v12i13.44144. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/44144. Acesso em: 13 nov. 2024.

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Section

Health Sciences