For older patients with plasma cell myeloma, first-line treatment combinations of lenalidomide, bortezomib, and dexamethasone (RVD) may provide outcomes superior to those seen with certain doublet regimens, according to results of a retrospective study published in the American Journal of Hematology.
The study made use of real-world data with first-line regimens used to treat plasma cell myeloma in Medicare beneficiaries from 2007 to 2015. RVD was compared with the following combinations: lenalidomide with dexamethasone (RD), bortezomib with dexamethasone (VD), and VD with cyclophosphamide (VCD). Multiple treatment outcomes were evaluated, and comparisons were adjusted based on propensity scores.
A total of 6076 patients were included in this analysis, among whom the median age was 76 years. The median study follow-up was 4.6 years. For the whole study population, the median overall survival (OS) duration was 2.6 years (95% CI, 2.5-2.7). A total of 891 patients received RVD in this analysis, 1541 received RD, 1672 were treated with VD, and 444 had VCD.
When comparing RVD with RD or VD combinations, the OS was superior with RVD (hazard ratio [HR], 0.83; 95% CI, 0.72-0.95). Estimated 3-year OS was 53% with RVD and 47% with RD or VD, and the median OS was 3.4 years with RVD, compared with 2.7 years using either doublet. Additionally, event-free survival (EFS) was superior with RVD compared with either RD or VD (HR, 0.68; 95% CI, 0.61-0.76).
In a comparison between RD and VD, OS appeared slightly better with RD (HR, 0.91; 95% CI, 0.83-0.99). EFS also appeared to be better with RD than with VD (HR, 0.74; 95% CI, 0.68-0.81). Comparisons of VCD with VD did not show significant differences in any measured outcomes.
RVD was associated with a higher cost compared with RD or VD. In the first year of treatment, the mean Medicare spending for inpatient or outpatient services was $19,103 higher with RVD than with the doublets overall. For prescription drugs, RVD showed $15,379 higher mean Medicare spending than seen with the doublets overall. Costs for medical services were lower with RD than with VD, but higher for prescription costs.
In terms of safety, risks of neuropathy, hospitalizations, and anemia were significantly higher with RVD than with RD or VD. Compared with VD, RD showed a greater risk of thromboembolism, but lower risk of neuropathy.
“In conclusion, our real-world comparison of first-line regimens in older Medicare beneficiaries with myeloma revealed improved outcomes with the RVD triplet compared with RD/VD doublets, unexpected advantage of RD over VD, and lack of advantage of VCD over VD alone,” concluded the researchers in their report.
Disclosures: Some authors have declared affiliations with or received grant support from the pharmaceutical industry. Please refer to the original study for a full list of disclosures.
Barth P, Giri S, Reagan JL, Olszewski AJ. Outcomes of lenalidomide- or bortezomib-based regimens in older patients with plasma cell myeloma. Am J Hematol. Published September 11, 2020. doi:10.1002/ajh.25996