Recently Diagnosed or Relapsed? Stop Looking For a Miracle Cure, and Use Evidence-Based Therapies To Enhance Your Treatment and Prolong Your Remission
Multiple Myeloma an incurable disease, but I have spent the last 25 years in remission using a blend of conventional oncology and evidence-based nutrition, supplementation, and lifestyle therapies from peer-reviewed studies that your oncologist probably hasn't told you about.
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D-RVD vs. RVD as Myeloma Induction
D-VRD vs. RVD as myeloma induction therapy. Do you care? Why or why not? Both chemo combinations are effective.
However, the FDA says that there is one single standard-of-care therapy plan for all newly diagnosed MM patients regardless of:
- Stage at diagnosis
- Age at diagnosis
- Physical condition
- Patient’s goals
According to the study linked below, DRVD patients responded better than RVD patients by a whopping 2.5%. I would argue that the patient’s age, stage and physical condition has a greater impact on the overall response rate than the type of chemo combo did.
More importantly, patients who underwent DVRD induction therapy had a greater risk of side effects than the RVD group did.
And I would guess that patients who underwent even less toxicity but undergoing RVD Lite would have even lower risk of side effects.
Which induction therapy has a greater risk of adverse events D-RVD or RVD for myeloma?
D-RVD (Daratumumab, Lenalidomide, Bortezomib, and Dexamethasone)
Common Adverse Events:
- Infusion-related reactions (due to daratumumab)
- Higher risk of infections
- Hematologic toxicities (neutropenia, thrombocytopenia)
- Gastrointestinal symptoms
- Fatigue
RVD (Lenalidomide, Bortezomib, and Dexamethasone)
Common Adverse Events:
- Peripheral neuropathy (due to bortezomib)
- Gastrointestinal symptoms
- Hematologic toxicities (neutropenia, thrombocytopenia)
- Fatigue
- Increased risk of thromboembolic events (due to lenalidomide)
Comparative Risk of Adverse Events
Adding daratumumab to the RVD regimen increases the complexity of the treatment and introduces additional adverse events, particularly related to the immunotherapy component. Studies have shown that DRVD is generally associated with higher rates of infusion-related reactions and a higher incidence of infections compared to RVD. However, the overall toxicity profile can vary among patients, and the decision to use DRVD versus RVD often depends on the patient’s overall health, prior treatments, and specific myeloma characteristics.
In my experience as both a MM survivor and MM cancer coach, I’ve seen oncology being tone deaf to side effects. Meaning, oncology thinks like a doctor and less like a patient. D-VRD vs. RVD as myeloma induction therapy is an excellent example of this attitude.
If you would like to learn more about evidence-based therapies to improve your overall response to chemotherapy while reducing your risk of side effects, email me at David.PeopleBeatingCancer@gmail.com
Thank you,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Comparison of Response and Survival Outcomes in Standard- and High-Risk Newly Diagnosed Transplant-Eligible Multiple Myeloma (NDMM) Patients Treated with Lenalidomide, Bortezomib and Dexamethasone (RVD) Versus Daratumumab, Lenalidomide, Bortezomib and Dexamethasone (D-RVD)
“Introduction: The combination of lenalidomide, bortezomib, and dexamethasone (RVD) is highly effective for newly diagnosed myeloma (NDMM) patients. However, the addition of daratumumab to RVD (D-RVD) has shown improved depth of response and trend towards PFS benefit.
Here, we present a real-world comparison of the largest cohort of patients consecutively treated with either D-RVD or RVD induction therapy in terms of response and long-term outcomes for both standard- and high-risk patients…
Results: Patient characteristics for DRVD vs RVD are found in Table 1. Of note, for DRVD vs RVD, 13.8% vs 15.8% had HR disease, and 16% vs 23.3% had ISS 3 and 4.6% vs 11.5% with RISS 3 disease. 98.6% and 99.7% of patients in the RVD vs D-RVD cohorts underwent ASCT.
High-risk disease was defined as presence of del(17p), t(4;14), t(4;16), and complex karyotype.
Post-induction overall response rate (ORR) was 99.6% in D-RVD versus 97.1% in RVD, with ≥VGPR rates of 86.5% vs 67.6%, respectively.
Post-transplant ORR was 99.3% vs 98.5%, with ≥VGPR rates of 95.6% vs 86.8%, respectively. Though the median follow-up for the Dara-RVD cohort is significantly shorter (19.1 months) compared to the RVD cohort (88.4 months), there is already a PFS benefit demonstrated with quadruplet induction for both standard- and high-risk patients.
For all patients, the 2-year PFS and OS for D-RVD vs RVD is 93% and 94% compared to 82% and 91%, respectively.
For standard risk patients, the 2-year PFS for D-RVD vs RVD is 94% vs 84%, and for high risk patients, 83% vs 69%, respectively. 2-year OS for standard risk patients was 96% in D-RVD vs 93% in RVD, and 94% vs 79% in HR patients, respectively. OS estimates for HR patients also favored D-RVD, though this is more likely than PFS to be impacted by changes in treatment patterns over the past decade.
Conclusions: D-RVD is a highly effective induction regimen that can improve upon outcomes in a historical NDMM population treated with RVD in terms of depth of response and PFS benefit. In the absence of phase 3 data supporting D-RVD vs RVD as standard of care induction, this analysis provides evidence of benefit with the addition of daratumumab to RVD in increasing depth of response, and provides an early glimpse of the promising PFS and OS benefit not only in standard risk patients, but also in patients with high-risk cytogenetic and disease features.”