Bortezomib – in the light of the 2004 Nobel Prize. New perspectives in multiple myeloma treatment

Results of multiple myeloma treatment are unsatisfactory. It seems that all recently available cytostatics have reached their therapeutic efficacy. New targets for multiple myeloma treatment are constantly searched for. Last year’s Nobel Prize in chemistry was granted for research on proteasome, an enzymatic complex playing a crucial role in intracellular protein degradation, including the proteins participating in the cell cycle, transcription factor activation and apoptosis. Bortezomib is a strong proteasome inhibitor, registered in resistant/refractory multiple myeloma treatment. The proteasome blockade results in cancer growth inhibition. Numerous clinical data show that bortezomib is effective in patients with multiple myeloma who failed two or more treatment lines. Almost half of those patients have a chance for clinical remission while on bortezomib. This therapy doubles the mean time to progression and allows almost twofold increase in overall survival in comparison with results obtained in the next chemotherapy treatment line. Bortezomib is well tolerated. During this therapy improvement in the quality of life, mainly due to chronic pain and fatigue decrease, is described. There are recent data on bortezomib as a salvage therapy for multiple myeloma patients who failed on high dose chemotherapy with allogenic bone transplant. Studies on concomitant use of bortezomib with cytostatics and on bortezomib efficacy in other hematological malignancies and solid tumors are underway.