Introduction: We conducted a single-arm, open-label dose-exploration study to evaluate the safety and efficacy of the histone deacetylase inhibitor tucidinostat combined with bortezomib, liposomal doxorubicin, and dexamethasone (C-PDD) in treating relapsed and refractory multiple myeloma (RRMM) patients. Methods: Eighteen patients were enrolled from August 2020 to May 2021, receiving 21-day cycles of C-PDD. Results: Eighteen cases were analysed, with a median prior treatment line of 2 (range: 1–4). The median number of completed treatment cycles was 4 (range: 1–8). The overall response rate was 57%, including 14% complete response, 14% very good partial response, and 29% partial response. Both bortezomib-sensitive and refractory groups had a response rate of 57%. The response rate was 100% in patients with extramedullary extraosseous involvement. The median follow-up was 42 months (range: 3–44), with median progression-free survival of 7 months and median overall survival of 24.5 months. Grade 3–4 haematologic adverse events included thrombocytopaenia (50%), neutropenia (33%), and anaemia (33%). Non-haematologic adverse events were mostly grade 1–2, with 1 case of grade 3 peripheral sensory neuropathy. Conclusion: The C-PDD regimen showed efficacy in RRMM, including bortezomib-refractory disease and EME patients. The optimal dose and combination need to be explored in the future.

1.
Wang
S
,
Xu
L
,
Feng
J
,
Liu
Y
,
Liu
L
,
Wang
J
, et al
.
Prevalence and incidence of multiple myeloma in urban area in China: a national population-based analysis
.
Front Oncol
.
2019
;
9
:
1513
.
2.
Liu
W
,
Liu
J
,
Song
Y
,
Wang
X
,
Zhou
M
,
Wang
L
, et al
.
Mortality of lymphoma and myeloma in China, 2004-2017: an observational study
.
J Hematol Oncol
.
2019
;
12
(
1
):
22
.
3.
Lu
J
,
Lu
J
,
Chen
W
,
Huo
Y
,
Huang
X
,
Hou
J
, et al
.
Clinical features and treatment outcome in newly diagnosed Chinese patients with multiple myeloma: results of a multicenter analysis
.
Blood Cancer J
.
2014
;
4
(
8
):
e239
.
4.
Kumar
SK
,
Lee
JH
,
Lahuerta
JJ
,
Morgan
G
,
Richardson
PG
,
Crowley
J
, et al
.
Risk of progression and survival in multiple myeloma relapsing after therapy with IMiDs and bortezomib: a multicenter international myeloma working group study
.
Leukemia
.
2012
;
26
(
1
):
149
57
.
5.
Lecat
CSY
,
Taube
JB
,
Wilson
W
,
Carmichael
J
,
Parrish
C
,
Wallis
G
, et al
.
Defining unmet need following lenalidomide refractoriness: real-world evidence of outcomes in patients with multiple myeloma
.
Front Oncol
.
2021
;
11
:
703233
.
6.
Ohguchi
H
,
Hideshima
T
,
Anderson
KC
.
The biological significance of histone modifiers in multiple myeloma: clinical applications
.
Blood Cancer J
.
2018
;
8
(
9
):
83
.
7.
Mithraprabhu
S
,
Kalff
A
,
Chow
A
,
Khong
T
,
Spencer
A
.
Dysregulated Class I histone deacetylases are indicators of poor prognosis in multiple myeloma
.
Epigenetics
.
2014
;
9
(
11
):
1511
20
.
8.
Carew
JS
,
Giles
FJ
,
Nawrocki
ST
.
Histone deacetylase inhibitors: mechanisms of cell death and promise in combination cancer therapy
.
Cancer Lett
.
2008
;
269
(
1
):
7
17
.
9.
Mitsiades
CS
,
Mitsiades
NS
,
McMullan
CJ
,
Poulaki
V
,
Shringarpure
R
,
Hideshima
T
, et al
.
Transcriptional signature of histone deacetylase inhibition in multiple myeloma: biological and clinical implications
.
Proc Natl Acad Sci U S A
.
2004
;
101
(
2
):
540
5
.
10.
Orlowski
RZ
,
Nagler
A
,
Sonneveld
P
,
Bladé
J
,
Hajek
R
,
Spencer
A
, et al
.
Randomized phase III study of pegylated liposomal doxorubicin plus bortezomib compared with bortezomib alone in relapsed or refractory multiple myeloma: combination therapy improves time to progression
.
J Clin Oncol
.
2007
;
25
(
25
):
3892
901
.
11.
Mitsiades
N
,
Mitsiades
CS
,
Richardson
PG
,
Poulaki
V
,
Tai
Y-T
,
Chauhan
D
, et al
.
The proteasome inhibitor PS-341 potentiates sensitivity of multiple myeloma cells to conventional chemotherapeutic agents: therapeutic applications
.
Blood
.
2003
;
101
(
6
):
2377
80
.
12.
Orlowski
RZ
,
Stinchcombe
TE
,
Mitchell
BS
,
Shea
TC
,
Baldwin
AS
,
Stahl
S
, et al
.
Phase I trial of the proteasome inhibitor PS-341 in patients with refractory hematologic malignancies
.
J Clin Oncol
.
2002
;
20
(
22
):
4420
7
.
13.
Voorhees
PM
,
Gasparetto
C
,
Moore
DT
,
Winans
D
,
Orlowski
RZ
,
Hurd
DD
.
Final results of a phase 1 study of vorinostat, pegylated liposomal doxorubicin, and bortezomib in relapsed or refractory multiple myeloma
.
Clin Lymphoma Myeloma Leuk
.
2017
;
17
(
7
):
424
32
.
14.
Bondarev
AD
,
Attwood
MM
,
Jonsson
J
,
Chubarev
VN
,
Tarasov
VV
,
Schiöth
HB
.
Recent developments of HDAC inhibitors: emerging indications and novel molecules
.
Br J Clin Pharmacol
.
2021
;
87
(
12
):
4577
97
.
15.
Pan
D-S
,
Yang
Q-J
,
Fu
X
,
Shan
S
,
Zhu
J-Z
,
Zhang
K
, et al
.
Discovery of an orally active subtype-selective HDAC inhibitor, chidamide, as an epigenetic modulator for cancer treatment
.
MedChemComm
.
2014
;
5
(
12
):
1789
96
.
16.
Zhao
W
,
Zhu
J
,
Song
Y
,
Xu
P-P
,
Shen
J
,
Cai
Q
, et al
.
Tucidinostat plus R-CHOP in previously untreated diffuse large B-cell lymphoma with double expression of MYC and BCL2: an interim analysis from the phase III DEB study
.
J Clin Orthod
.
2024
;
42
(
17_Suppl l
):
LBA7003-LBA7003
.
17.
Zhang
H
,
Dong
L
,
Chen
Q
,
Kong
L
,
Meng
B
,
Wang
H
, et al
.
Synergistic antitumor effect of histone deacetylase inhibitor and Doxorubicin in peripheral T-cell lymphoma
.
Leuk Res
.
2017
;
56
:
29
35
.
18.
He
J
,
Chen
Q
,
Gu
H
,
Chen
J
,
Zhang
E
,
Guo
X
, et al
.
Therapeutic effects of the novel subtype-selective histone deacetylase inhibitor chidamide on myeloma-associated bone disease
.
Haematologica
.
2018
;
103
(
8
):
1369
79
.
19.
Xu
L
,
Feng
J
,
Tang
H
,
Dong
Y
,
Shu
M
,
Chen
X
.
Chidamide epigenetically represses autophagy and exerts cooperative antimyeloma activity with bortezomib
.
Cell Death Dis
.
2020
;
11
(
4
):
297
.
20.
Dong
M
,
Ning
Z-Q
,
Xing
P-Y
,
Xu
J-L
,
Cao
H-X
,
Dou
G-F
, et al
.
Phase I study of chidamide (CS055/HBI-8000), a new histone deacetylase inhibitor, in patients with advanced solid tumors and lymphomas
.
Cancer Chemother Pharmacol
.
2012
;
69
(
6
):
1413
22
.
21.
Shi
Y
,
Dong
M
,
Hong
X
,
Zhang
W
,
Feng
J
,
Zhu
J
, et al
.
Results from a multicenter, open-label, pivotal phase II study of chidamide in relapsed or refractory peripheral T-cell lymphoma
.
Ann Oncol
.
2015
;
26
(
8
):
1766
71
.
22.
Kumar
S
,
Paiva
B
,
Anderson
KC
,
Durie
B
,
Landgren
O
,
Moreau
P
, et al
.
International Myeloma Working Group consensus criteria for response and minimal residual disease assessment in multiple myeloma
.
Lancet Oncol
.
2016
;
17
(
8
):
e328
46
.
23.
Hideshima
T
,
Richardson
PG
,
Anderson
KC
.
Mechanism of action of proteasome inhibitors and deacetylase inhibitors and the biological basis of synergy in multiple myeloma
.
Mol Cancer Ther
.
2011
;
10
(
11
):
2034
42
.
24.
Muchtar
E
,
Gatt
ME
,
Rouvio
O
,
Ganzel
C
,
Chubar
E
,
Suriu
C
, et al
.
Efficacy and safety of salvage therapy using Carfilzomib for relapsed or refractory multiple myeloma patients: a multicentre retrospective observational study
.
Br J Haematol
.
2016
;
172
(
1
):
89
96
.
25.
Short
KD
,
Rajkumar
SV
,
Larson
D
,
Buadi
F
,
Hayman
S
,
Dispenzieri
A
, et al
.
Incidence of extramedullary disease in patients with multiple myeloma in the era of novel therapy, and the activity of pomalidomide on extramedullary myeloma
.
Leukemia
.
2011
;
25
(
6
):
906
8
.
26.
Waterman
GN
,
Yellin
O
,
Swift
RA
,
Mapes
R
,
Eades
B
,
Ackerman
E
, et al
.
A modified regimen of pegylated liposomal doxorubicin, bortezomib, and dexamethasone is effective and well tolerated in the treatment of relapsed or refractory multiple myeloma
.
Ann Hematol
.
2011
;
90
(
2
):
193
200
.
27.
Romano
A
,
Chiarenza
A
,
Conticello
C
,
Cavalli
M
,
Vetro
C
,
Di Raimondo
C
, et al
.
Salvage therapy with pegylated liposomal doxorubicin, bortezomib, cyclophosphamide, and dexamethasone in relapsed/refractory myeloma patients
.
Eur J Haematol
.
2014
;
93
(
3
):
207
13
.
28.
Berenson
JR
,
Yellin
O
,
Kazamel
T
,
Hilger
JD
,
Chen
CS
,
Cartmell
A
, et al
.
A phase 2 study of pegylated liposomal doxorubicin, bortezomib, dexamethasone and lenalidomide for patients with relapsed/refractory multiple myeloma
.
Leukemia
.
2012
;
26
(
7
):
1675
80
.
29.
Waldschmidt
JM
,
Keller
A
,
Ihorst
G
,
Grishina
O
,
Müller
S
,
Wider
D
, et al
.
Safety and efficacy of vorinostat, bortezomib, doxorubicin and dexamethasone in a phase I/II study for relapsed or refractory multiple myeloma (VERUMM study: vorinostat in elderly, relapsed and unfit multiple myeloma)
.
Haematologica
.
2018
;
103
(
10
):
e473
9
.
30.
Richardson
PG
,
Schlossman
RL
,
Alsina
M
,
Weber
DM
,
Coutre
SE
,
Gasparetto
C
, et al
.
Panorama 2: panobinostat in combination with bortezomib and dexamethasone in patients with relapsed and bortezomib-refractory myeloma
.
Blood
.
2013
;
122
(
14
):
2331
7
.
31.
San-Miguel
JF
,
Hungria
VTM
,
Yoon
S-S
,
Beksac
M
,
Dimopoulos
MA
,
Elghandour
A
, et al
.
Panobinostat plus bortezomib and dexamethasone versus placebo plus bortezomib and dexamethasone in patients with relapsed or relapsed and refractory multiple myeloma: a multicentre, randomised, double-blind phase 3 trial
.
Lancet Oncol
.
2014
;
15
(
11
):
1195
206
.
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