SWOG S0777 Trial Proves VRd To Be Viable Option for Untreated Myeloma That Is Unintended for ASCT
Ravi Vij, MD, MBA, discussed updated analyses of the phase 3 SWOG S0777 trial, supporting the use of bortezomib, lenalidomide, and dexamethasone in untreated patients with multiple myeloma who do not plan on receiving immediate autologous stem cell transplant.
As part of CancerNetwork’s Face-Off video series, Ravi Vij, MD, MBA, professor, Department of Medicine, Oncology Division, Bone Marrow Transplantation & Leukemia at Washington University School of Medicine in St. Louis, discussed results from the phase 3 SWOG S0777 trial (NCT00644228).
Vij: So we had great Face-Off [program] with the team at the University of Alabama in Birmingham. And we both had abstracts assigned to us. The [SWOG S0777] was the one that I presented. And this was the long-term follow up of the randomized phase 3 SWOG S0777 study that looked at bortezomib [Velcade], lenalidomide [Revlimid], and dexamethasone, comparing it to lenalidomide and dexamethasone, in patients with previously untreated myeloma who are not intended to go to stem cell transplant. Now this study has already been published, but the abstract and data that I was talking about at [the American Society of Hematology (ASH) Annual Meeting] was essentially the long-term follow-up that has only recently been updated and published.
This trial, most of the audience probably is familiar with because it forms the basis of 1 of the more popular regimens that we continue to use in our patients that we are not taking to stem cell transplant, and that is the 3-drug regimen of bortezomib, lenalidomide, and dexamethasone. In this update, what we saw was that, once again, with longer term follow-up that the data favored the 3-drug regimen over the 4-drug regimen, both in terms of the best response that was obtained by these patients with treatment, and also we see clearly, once again, the progression-free survival and overall survival of the groups was better with the 3-drug regimen.
The median progression-free survival for patients who got lenalidomide with bortezomib and dexamethasone was 41 months, compared to 29 months for lenalidomide and dexamethasone. The median overall survival for the 3-drug regimen was not reached and was about 69 months for lenalidomide and dexamethasone. There were subset analyses that were performed in this presentation. It was clear that the improvement seen with the 3-drug regimen was maintained even when adjusting for age. And this once again proves that VRd, or lenalidomide with bortezomib and dexamethasone is and remains an appropriate standard of care for patients, irrespective of age.
The key takeaway from the SWOG [S0777] study was that even with longer term follow-up that the superiority of the 3-drug regimen of bortezomib, lenalidomide, and dexamethasone is clear, compared to the 2-drug regimen of lenalidomide and dexamethasone, and this is irrespective of patient age, that you see this benefit. So I think that it remains a valid treatment option for patients irrespective of age.
As far as the findings of the SWOG study go, I think that it is something that will continue to support the use of this 3-drug regimen in patients with multiple myeloma who are not candidates for stem cell transplantation. There are a number of other options available for these patients. But this remains a viable option for patients as well.
Transcription edited for clarity.
