Joseph Mikhael, MD, Reviews Outcomes Following Lenalidomide/RVd and ASCT by Cytogenetic Risk in Myeloma

CancerNetwork^® spoke with Jospeh Mikhael, MD, professor of Applied Cancer Research and Drug Discovery Division at the Translational Genomics Research Institute (TGen), an affiliate of City of Hope; chief medical officer of the International Myeloma Foundation; and councilor on the American Society of Hematology Executive, about which presentations from the 2022 International Myeloma Society Conference he found most interesting. He detailed findings from the phase 3 DETERMINATION trial (NCT01208662,) that detailed survival benefit by cytogenetic risk in patients with newly diagnosed multiple myeloma treated with a regimen of lenalidomide (Revlimid), bortezomib (Velcade), and dexamethasone (RVd) followed by autologous stem cell transplant and lenalidomide maintenance.

At a median follow-up of 76 months, the median progression-free survival was 46 months for patients who received RVd vs 67.5 months for those who received RVd and autologous stem cell transplant (HR, 1.53; 95% CI, 1.23-1.91; P <.0001). Moreover, the median PFS was 17.1 months vs 55.5 months in the high cytogenetic risk population and 53.2 months vs 82.3 months in the standard-risk population, respectively (HR, 1.38; 95% CI, 1.07-1.79).

Transcript:

It’s hard to choose 1 specific presentation amid so many great things that are coming. I would just broadly note that it was exciting to see further advances in these fields—to see updated results with bispecific therapies and CAR T-cell therapies. It was interesting to see another update in the DETERMINATION trial that was [previously presented] at an ASCO [American Society of Clinical Oncology] plenary session that I had the privilege of being the discussant of where we looked a little bit more carefully at the difference in outcome based on risk status.

The DETERMINATION trial was a US [United States]-based study that was giving patients RVd—lenalidomide, bortezomib, and dexamethasone—plus or minus a transplant followed by indefinite lenalidomide maintenance. It had demonstrated that there was a significant progression-free survival advantage, having had a transplant, of over 20 months. Interestingly, overall survival was the same in the 2 groups. In this presentation by Paul G, Richardson, MD, at the IMS, they were looking at the differences in outcomes between the high-risk patients and the standard-risk patients. There was a particularly impressive benefit in the progression-free survival in that high-risk group. Whether or not it immediately tells us that we should be transplanting all high-risk patients remains an interesting area of debate and discussion. It is helping us recognize that transplant is a valuable tool in myeloma. We may not necessarily always have to use it immediately up-front treatment, but in higher-risk patients, we may be tempted to do so to ensure that they have that option because it may not be available to them later.

Reference

Richardson PG, Jacobus, SJ, Weller EA, et al. Lenalidomide-bortezomib-dexamethasone (RVd) ± autologous stem cell transplantation (ASCT) and R maintenance to progression in patients with newly diagnosed multiple myeloma (NDMM), by cytogenetic risk. Presented at the 19th Annual International Myeloma Society (IMS) Annual Meeting; August 25-27, 2022; Los Angeles, CA. Abstract OAB-058