Treatments containing bortezomib or lenalidomide appear to be similarly efficacious in patients with multiple myeloma (MM) at first relapse, according to results from the first head-to-head comparison of the 2 treatments to date.

The open-label, randomized, phase 3 study was recently published in the British Journal of Haematology. Patients were given a fixed duration (9 cycles, 6 induction and 3 consolidation) of bortezomib, cyclophosphamide, and dexamethasone (VCD) or lenalidomide, cyclophosphamide, and dexamethasone (RCD). The primary end point was achievement of very good partial response (VGPR) or better at 6 weeks after treatment.

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Overall, 155 patients with a median age 63 years were included in the study and randomly assigned to receive VCD (76 patients) or RCD (79 patients). Median progression-free survival (PFS) with first-line therapy was 3 years (range, 10-51 months). Approximately half of patients (51%) had previously received bortezomib, while 40% and 9% had received conventional chemotherapy and lenalidomide-based treatment, respectively.

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VGPR or better was achieved by 15% of patients in the VCD arm and 18% of patients in the RCD arm (P =.70). Median PFS was 16.3 months (95% CI, 12.1-22.4) with VCD and 18.6 months (95% CI, 14.7-25.5) with RCD. The 2-year rate of overall survival was 75% (95% CI, 66%-86%) with VCD and 74% (95% CI, 64%-85%) with RCD. Subgroup analyses did not reveal differences in PFS in bortezomib- and lenalidomide-naive patients or in patients who received bortezomib in first-line therapy.

The safety profiles for both treatment regimens were consistent with those previously reported.

The researchers noted that these results should be considered with caution because they were not able to enroll at least 186 patients, the number needed to have a statistical power of 85%.

Given the study results and that both drugs have reasonably low cost, the researchers noted that “the choice of treatment should therefore be based on patients’ characteristics and preferences, residual toxicities, and drug class sequencing.”


1.     Montefusco V, Corso A, Galli M, et al. Bortezomib, cyclophosphamide, dexamethasone versus lenalidomide, cyclophosphamide, dexamethasone in multiple myeloma patients at first relapse [published online January 2, 2020]. Br J Haematol. bjh.16287. doi:10.1111/bjh.16287