FACULTY COMMENTS
DR RICHARDSON: Our Phase I/II study combined bortezomib
with the lenalidomide/ dexamethasone couplet in the up-front
setting.
We had preclinical data to suggest that the triplet was at least additive and possibly synergistic. Clinical experience in the relapsed/refractory setting demonstrated that this drug regimen was active, even in patients in whom either bortezomib or lenalidomide had failed.
We identified a maximally tolerated dose in the up-front setting of 1.3 mg/m2 of bortezomib, 25 milligrams of lenalidomide and dexamethasone at 20 milligrams, administered according to the protocol schedule. This translated into a 98 percent overall response rate using EBMT criteria, with 100 percent of patients treated at the maximum planned dose achieving PR or better.
We also observed low rates of deep vein thrombosis and peripheral neuropathy, and generally the toxicity profile of the combination proved manageable.
The regimen is already moving into a Phase III clinical trial through ECOG, led by my colleague Dr Rafael Fonseca, in which Rev/Vel/Dex is compared to bortezomib and dexamethasone. Also, Brian Durie from SWOG is testing Rev/Vel/Dex versus lenalidomide and low-dose dexamethasone. Participation in these clinical trials is especially encouraged, and other studies using the Rev/Vel/Dex platform are also underway.
DR LONIAL: Many of us believe now that Rev/Vel/Dex is probably
the backbone on which we’re going to start adding other drugs to
build a CHOP-like regimen for myeloma.
DR ORLOWSKI: In the future, Rev/Vel/Dex may prove to be the
best regimen for all patients.
Being able to achieve response rates of close to 100 percent with shorter durations of therapy is encouraging.
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