A team of investigators from Winship Cancer Institute of Emory University (Winship) has shown outstanding long-term survival results for multiple myeloma patients from a 3-drug induction regimen in a study published today in the Journal of Clinical Oncology. The study describes the largest cohort of patients treated with a combination of lenalidomide, bortezomib, and dexamethasone (RVD) with the longest follow up reported to date.
The study followed 1,000 consecutive patients with newly diagnosed myeloma, both transplantation-eligible and -ineligible, who were treated with RVD induction therapy from January 2007 until August 2016. The study proves this induction regimen has good safety profile in the long run and highly effective in managing multiple myeloma, a cancer caused by malignant plasma cells in the bone marrow.
"Looking at a large cohort of patients over a long period of time, we were able to provide a more comprehensive picture of the overall treatment course with RVD as induction therapy," says Winship hematologist Ajay K. Nooka, MD, MPH, senior author. "We have seen our patients attain excellent results from RVD, so it's gratifying to corroborate those results in this study."
The study describes the RVD induction regimen as part of the significant therapeutic advances in myeloma over the past few decades that have led to an improved survival benefit for patients. Winship hematologist Nisha S. Joseph, MD, first author on the paper, says "Our study demonstrates not only the efficacy of the RVD induction regimen in attaining deep responses, but also the benefit of risk-stratified and continuous maintenance therapy in positively impacting long-term survival."
The study's outcomes are based on genetic risk at diagnosis, progression-free survival, overall survival, and the impact of genetics on the quality and depth of response. In addition to the overall size of the patient cohort, another major strength of the study's data set is that 35.2% of patients were African American (AA), which is consistent with the demographics of the myeloma population served by Winship.
"Large data sets like ours with 352 African-American patients receiving uniform therapy help to reassure that AA patients derive a similar benefit as their white counterparts if offered the same therapeutic care," according to Nooka and Joseph.
The study was initiated at Winship and includes 10 Winship investigators: Nisha S. Joseph, MD; Jonathan L. Kaufman, MD; Madhav V. Dhodapkar, MD; Craig C. Hofmeister, MD; Dhwani K. Almaula, MBBS, MPH; Leonard T. Heffner, MD; Vikas A. Gupta, MD, PhD; Lawrence H. Boise, PhD; Sagar Lonial, MD; and Ajay K. Nooka, MD, MPH.
"This study highlights our strengths as a unified program with consistent practice and collaboration with our colleagues in the community. These data have set a new bar for outcomes outside of a clinical trial, and support a comprehensive treatment approach for patients from the time of diagnosis." says Lonial, Winship chief medical officer, chair of the Emory Department of Hematology and Medical Oncology, and holder of the Anne and Bernard Gray Family Chair in Cancer. "This work will impact the treatment of myeloma patients everywhere."