Phase 2 studies of lenalidomide, subcutaneous bortezomib, and dexamethasone as induction therapy in patients with newly diagnosed multiple myeloma

Abstract

There are limited prospective data on lenalidomide, subcutaneous bortezomib, and dexamethasone (RsqVd) in transplant-eligible/transplant-ineligible patients with newly diagnosed multiple myeloma. Reliable biomarkers for efficacy and toxicity are required to better tailor therapy. Two parallel studies were conducted by Cancer Trials Ireland (CTI; NCT02219178) and the Dana-Farber Cancer Institute (DFCI; NCT02441686). Patients received four 21-day cycles of RsqVd and could then receive either another 4 cycles of RsqVd or undergo autologous stem cell transplant. Postinduction/posttransplant, patients received lenalidomide maintenance, with bortezomib included for high-risk patients. The primary endpoint was overall Peter O'Gorman and Jacob P. Laubach are the co-first authors.

Lenalidomide, bortezomib and dexamethasone induction therapy for the treatment of newly diagnosed multiple myeloma: a practical review

“…As shown in a recent report 39 and prior published experience 69 , 70 neuropathy may be in part prevented or mitigated by the infusion of normal saline at the time of bortezomib administration, as well as other supportive measures including emollients.…”

“…If this approach is being utilised, the administration of intravenous normal saline may be helpful to minimise neurotoxicity and fatigue. 39 The optimal number of cycles of RVD prior to ASCT remains to be defined with most clinicians utilising three to six cycles. A balance between obtaining best response and toxicity is advisable.…”

“…Higher bortezomib doses, up to 1.5–1.6 mg/m 2 are sometimes utilised in weekly protocols 37,38 to facilitate more convenient clinical visits and optimise dose intensity. If this approach is being utilised, the administration of intravenous normal saline may be helpful to minimise neurotoxicity and fatigue 39 …”

“…If this approach is being utilised, the administration of intravenous normal saline may be helpful to minimise neurotoxicity and fatigue. 39 …”

Clinical perspectives on the optimal use of lenalidomide plus bortezomib and dexamethasone for the treatment of newly diagnosed multiple myeloma

“…Most commonly, RVd was administered in 21-day cycles, with lenalidomide 25 mg on days 1-14 and bortezomib 1.3 mg/m 2 (IV or SC) on days 1, 4, 8, and 11; some studies used dexamethasone 40 mg once weekly, 29 , 30 and others split the dose to 20 mg on days of and after bortezomib (“partnered dosing”, totaling 80 mg/week). 32 , 33 , 37 , 41 , 43 Importantly, although weekly dexamethasone may be more convenient for some patients, the severity of bortezomibinduced PN may be mitigated by partnered dosing. 60 …”