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.
Click the orange button to the right to learn more about what you can start doing today.
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- Pollux- RVd Induction + DRd longest OS?
Pollux- RVd Induction + DRd longest OS?
Does the Pollux trial provide a real alternative to maintenance therapy? But not maintenance therapy as in month after month for years. I am wondering about standard induction reaching VGPR, CR, etc. Therapy vacation.
- Once the patient relapses-
- Daratumumab, Rev. Dex-
Low-dose maintenance therapy- usually 10 or 15 mg. of revlimid aka lenalidomide, has been the standard-of-care following induction therapy and an autologous stem cell transplant, for years now.
According to the Pollux trial linked below, Daratumumab, lenalidomide and dexamethasone results in a longer progression-free survival and possibly longer overall survival.
More importantly, consider the combination of the standard-of-care for newly diagnosed myeloma patients- RVd or revlimid, velcade and dexamethasone as your first or induction therapy. This induction triplet has proven to be the best risk vs. reward trade-off for the 96% of NDMM patients who are stage 2 or 3 at diagnosis and need to be stabilized.
RVd for your induction followed by DLd when you relapse? My guess is that the pollux trial was conducted to study therapies that might outperform the current standard maintenance therapy of low dose revlimid and dexamethasone. Maintenance therapy is designed to follow the patients autologous stem cell transplant.
My goal is presenting these two studies is to provide longer overall survival with NO stem cells transplant. Less chemo, less toxicity.
But what if you wait for one, two, three or fours years before you undergo DLd? By themselves, these chemo-cocktails offer superior progression-free survival (PFS) as well as overall survival (OS) when compared to other therapies. What will happen if you have a therapy vacation in between RVd and DLd?????
Let me throw you another therapy curve. Include evidence-based but non-conventional therapies in your therapy plan to include
- anti-angiogenic nutrition and supplementation
- anti-myeloma lifestyle therapies
One thing is for sure. You will give your board-certified, myeloma specialist, oncologist fits.
Scroll down the page, post a question or comment. I will reply to you ASAP.
Hang in there,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Overall Survival With Daratumumab, Lenalidomide, and Dexamethasone in Previously Treated Multiple Myeloma (POLLUX): A Randomized, Open-Label, Phase III Trial
PURPOSE-With the initial analysis of POLLUX at a median follow-up of 13.5 months, daratumumab in combination with lenalidomide and dexamethasone (D-Rd) significantly prolonged progression-free survival versus lenalidomide and dexamethasone (Rd) alone in patients with relapsed or refractory multiple myeloma (RRMM)…
METHODS- POLLUX was a multicenter, randomized, open-label, phase III study during which eligible patients with ≥ 1 line of prior therapy were randomly assigned 1:1 to D-Rd or Rd until disease progression or unacceptable toxicity…
RESULTS- Significant OS benefit was observed with D-Rd at a median (range) follow-up of 79.7 (0.0-86.5) months.
The median OS was 67.6 months for D-Rd compared with 51.8 months for Rd. Prespecified analyses demonstrated an improved OS with D-Rd versus Rd in most subgroups, including patients age ≥ 65 years and patients with one, two, or three prior lines of therapy,
International Staging System stage III disease, high-risk cytogenetic abnormalities, and refractoriness to their last prior line of therapy or a proteasome inhibitor.
The most common (≥ 10%) grade 3/4 treatment-emergent adverse events with D-Rd versus Rd were neutropenia (57.6% v 41.6%), anemia (19.8% v 22.4%), pneumonia (17.3% v 11.0%), thrombocytopenia (15.5% v 15.7%), and diarrhea (10.2% v 3.9%)…
CONCLUSION- D-Rd significantly extended OS versus Rd alone in patients with RRMM. To our knowledge, for the first time, our findings, together with the OS benefit observed with daratumumab plus bortezomib and dexamethasone in the phase III CASTOR trial, demonstrate OS improvement with daratumumab-containing regimens in RRMM (ClinicalTrials.gov identifier: NCT02076009 [POLLUX])…”
Triplet RVd Induction for Transplant-Eligible Newly Diagnosed Multiple Myeloma: A Systematic Review and Meta-Analysis
“Introduction: The combination of lenalidomide, bortezomib, and dexamethasone (RVd) has become standard of care for transplant-eligible patients with newly diagnosed MM (NDMM). This study aimed to determine the efficacy of RVd as induction therapy in terms of response rates and survival outcomes of transplant-eligible patients with NDMM…
Methods: The databases of Medline, Embase, and Cochrane Library were searched until February 1, 2021. Both randomized controlled trials (RCT) and non-RCTs from the available literature were extracted as one-arm data to assess the efficacy of each triplet regimen for the target patients in terms of response rates and survival rates for transplant-eligible patients with NDMM…
Results: The findings of 71 studies published from 2008 to 2020 were analyzed. For RVd induction, the overall response rate (ORR), very good partial response or better (≥ VGPR) rate, and complete response or better (≥ CR) rate after induction were 0.91, 0.23, and 0.56, respectively.
Indirect comparisons in efficacy were made between RVd and other traditional triplet regimens. RVd induction led to a better ≥ CR rate than bortezomib, cyclophosphamide, and dexamethasone (VCd) regimen in both postinduction and post-ASCT phase, ≥ CR rate 0.11 and 0.21, respectively.
The 1-year overall survival (OS) rate and 3-year OS rate of RVd regimen were longer than that of bortezomib, thalidomide, and dexamethasone (VTd), 0.97 vs 0.71, and 0.90 vs 0.70, respectively…”