by Cheryl G on Tue Feb 19, 2019 11:33 am
I am surprised at the posts in this thread that make it sound like it is some sort of super special secret, or astounding discovery, that adding a known myeloma therapy such as Revlimid and Velcade to Darzalex and dexamethasone will improve responses and lengthen times in remission.
You can almost always deepen the response of a myeloma treatment regimen by adding one or more known myeloma therapies. This is especially true with myeloma patients who have not received many prior therapies, and it's especially true when you add therapies from different drug classes.
So, if you want to improve response rates for the combination of Pomalyst and dexamethasone, for example, add Kyprolis, Darzalex, Empliciti, or cyclophosphamide (just as a few examples).
If you want to improve the response rate of Velcade and dexamethasone, as another example, add Revlimid or Darzalex or cyclophosphamide or even doxorubicin.
The two main reasons most doctors don't recommend five-, six-, or seven-drug treatment regimens are:
1. The side effects become a problem with so many drugs being given to the patient.
2. It is not clear that the deeper responses up front with more intensive therapy lead to longer OVERALL survival.
The deeper responses associated with intensive multidrug therapies almost always lead to longer times in remission, measured as progression-free survival. What is not yet known is how many of those more intensive therapies lead to longer overall survival. It has happened in one or two studies (I'm thinking particularly of the SWOG S0777 study comparing Revlimid, Velcade, and dexamethasone to just Revlimid and dexamethasone, which is the reason that RVD has become so common an initial treatment for myeloma in the U.S.), but it is not an extensively documented outcome.
