Dr. Brian GM Durie, International Myeloma Foundation, presents an abstract on the efficacy and safety bortezomib-lenalidomide-dexamethasone based on age.

Background:

The SWOG S0777 phase 3 randomized controlled trial demonstrated that treatment with bortezomib-lenalidomide-dexamethasone (VRd) resulted in superior progression-free survival (PFS) and overall survival (OS) compared to lenalidomide-dexamethasone (Rd) alone in patients with newly diagnosed multiple myeloma (NDMM) without intent for immediate transplant. The trial population included a combination of transplant-ineligible patients and transplant-eligible patients who chose to defer or decline upfront autologous stem transplantation. The present stratified analyses explored possible treatment effect heterogeneity based on age, with a cutpoint of ≥65 years used as a proxy for transplant eligibility status (Mian, J Geriatr Oncol, 2020).

Conclusions:

The present analyses shed light on possible treatment effect heterogeneity based on age in the SWOG S0777 trial. The estimated relative benefit of VRd vs. Rd with respect to both PFS and OS was smaller in magnitude for patients aged ≥65 years (proxy for transplant ineligible) relative to patients <65 years (proxy for transplant deferred). In addition, grade ≥3 TEAEs and treatment discontinuations due to toxicity were higher in both treatment arms in patients aged ≥65 years relative to younger patients. Limitations of the present study include the fact that it was a post hoc subgroup analysis with a limited number of patients within each age stratum, and issues of generalizability of these findings to the contemporary use of VRd in older patients with NDMM where better-tolerated subcutaneous bortezomib and modified dosing schedules may be preferred. Anticipated read-outs from ongoing trials of VRd in transplant-ineligible patients with NDMM using subcutaneous bortezomib may help to further clarify the level of benefit of VRd in older adults with NDMM.

Authors:

Brian G.M. Durie, MD, Annette Lam, Mai Ngo, Huiling Pei, PhD, and Eric M. Ammann

ASH Abstract #4497: https://ash.confex.com/ash/2022/webprogram/Paper165591.html