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

• Type of Material: Article
• Authors: Paul G. Richardson, Harvard University; Brian G. Durie, Cedars-Sinai Samuel Oschin cancer Center; Laura Rosiñol, University of Barcelona; Maria-Victoria Mateos, University Hospital of Salamanca; Angela Dispenzieri, Mayo Clinic, Rochester; Philippe Moreau, University Hospital Hôtel-Dieu; Shaji Kumar, Mayo Clinic, Rochester; Noopur Raje, Massachusetts General Hospital; Nikhil Munshi, Harvard University; Jacob P. Laubach, Harvard University; Peter O'Gorman, University College Dublin; Elizabeth O'Donnell, Massachusetts General Hospital; Peter Voorhees, Levine Cancer Institute; Thierry Facon, Centre Hospitalier Universitaire Lille; Joan Bladé, University of Barcelona; Sagar Lonial, Emory University; Aurore Perrot, Institut Universitaire du Cancer de Toulouse-Oncopole; Kenneth C. Anderson, Harvard University
• Language: English
• Date: 2023-08-24
• Publisher: Ferrata Storti Foundation
• Publication Version: Final Published Version
• Copyright Statement: © 2023 Ferrata Storti Foundation
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): https://doi.org/10.3324/haematol.2022.282624
• Title of Journal or Parent Work: Haematologica
• Volume: 108
• Issue: 11
• Start Page: 2894
• End Page: 2912
• Grant/Funding Information: Funding for medical writing assistance in the preparation of this manuscript was provided by a grant from Celgene, a Bristol Myers Squibb Company, with editorial support also funded by the RJ Corman Multiple Myeloma Research Fund.
• Keywords: bortezomib; dexamethasone; newly diagnosed multiple myeloma; lenalidomide; hematologic malignancy of multiple myeloma
• Research Categories: Health Sciences, Oncology; Health Sciences, Public Health

Abstract

To improve the outcomes of patients with the otherwise incurable hematologic malignancy of multiple myeloma (MM), a key paradigm includes initial treatment to establish disease control rapidly followed by maintenance therapy to ensure durability of response with manageable toxicity. However, patients’ prognosis worsens after relapse, and the disease burden and drug toxicities are generally more challenging with subsequent lines of therapy. It is therefore particularly important that patients with newly diagnosed multiple myeloma (NDMM) receive optimal frontline therapy. The combination of lenalidomide, bortezomib, and dexamethasone (RVd) has consistently demonstrated a tolerable safety profile with significant and clinically relevant benefit, including deep and durable responses with improved survival in patients with NDMM regardless of their transplant eligibility. Furthermore, comparative studies evaluating this triplet regimen against both doublet and other triplet regimens have established RVd as a standard of care in this setting based upon its remarkable and concordant efficacy. Given the breadth of clinical data, physician familiarity, inclusion in treatment guidelines, and the emerging potential of RVd-containing quadruplet regimens, RVd will likely continue as a key cornerstone of the treatment of NDMM, and its role will therefore likely continue to grow as a therapeutic backbone in the initial treatment of MM.