Lenalidomide/bortezomib/dexamethasone (RVd) induction followed by continuous lenalidomide/dexamethasone (Rd) was demonstrated to be superior to continuous Rd in patients with newly diagnosed multiple myeloma (MM), without an intent for immediate autologous stem cell transplant (ASCT), prolonging both progression free survival (PFS) and overall survival (OS) in SWOG S0777.r It should be noted that the patient population in SWOG S0777 is not the typical transplant ineligible population seen in Australia, with 57% of patients aged less than 65 (62% in the RVd arm).r
525 patients were randomised in the SWOG S0777 study, 264 in the RVd group and 261 in the Rd group. Updated results demonstrated a significantly prolonged PFS in patients randomised to receive RVd induction at 41 months compared to 29 months in those who were randomised to receive continuous Rd.r OS was also significantly prolonged in those randomised to RVd, with median OS not yet reached (but longer than 84 months), compared with 69 months with Rd.
Bortezomib was administered intravenously and on Day 1, 4, 8, 11 of a 21 day study in the SWOG S0777 study. Given the lower peripheral neuropathy rates seen with subcutaneous administration bortezomib it is the consensus of the eviQ reference committee that bortezomib should be administered subcutaneously.r Weekly bortezomib dosing has also been demonstrated to be associated with lower rates of peripheral neuropathy when incorporated into other regimens and this is a consideration for clinicians.r
Efficacy
Figure 1: Progression free survival and overall survival graphsr
© Blood 2020
Toxicity
The most common grade 3 or higher haematological toxicities were anaemia, lymphopenia, neutropenia and thrombocytopenia. Non-haematological toxicities were fatigue, sensory neuropathy, hyperglycaemia, thrombosis or embolism, hypokalaemia, muscle weakness, diarrhoea and dehydration.r
As expected, grade 3 or worse neurological toxic effects were more frequent in the RVd group (34.6%) than in the Rd group (11.3%).r
Toxicities of RVd and Rd in SWOG S0777r
© Lancet 2017