[MaxArt]

CyBorD / VCD or Darzalex, Velcade, and dexamethasone?

by MaxArt on Sat Dec 16, 2017 7:05 pm

I just started on Revlimid, Velcade, and dexamethasone ("light" version; 14 days on Revlimid and 7 days off) in September 2017, and have had several fits and starts.

For one thing, the Revlimid gave me a rash after only 5 days in cycle 1. We tried changing the dosage of Revlimid, but I still broke out in a rash. But even with the rash, my kappa free light chain level fell from 2200 down to 600 within three cycles.

I was all for staying on the Revlimid and just using other drugs to control the rash, but then after four cycles my kappa level went back up to 700 and then 900.

Now my oncologist says he thinks the Revlimid has stopped working and he has been looking for other drugs. I need to make a decision within the next week or two and the choices are

(1) CyBorD / VCD - Cyclophosphamide (tablets) in place of Revlimid with Velcade and dexamethasone (20 mg), or

(2) Darzalex infusions once per week with Velcade and dexamethasone.

Any info about the two options would be appreciated.

[Ian]

Re: CyBorD / VCD or Darzalex, Velcade, and dexamethasone?

by Ian on Mon Dec 18, 2017 6:28 am

Hi MaxArt,

I don't think any study results have been published that make it easy to compare how well the two regimens you're considering will work for you.

As far as I know, CyBorD has been studied primarily with newly diagnosed myeloma patients, while results for Darzalex, Velcade, and dexamethasone have been published only for relapsed and refractory myeloma patients.

That said, my personal guess is that the Darzalex, Velcade, and dexamethasone regimen will get you a deeper response that CyBorD / VCD. This is mainly because I think Darzalex is a more powerful anti-myeloma agent than cyclophosphamide.

Also, if you are planning to get a stem cell transplant after your initial therapy, I suspect that pairing a transplant with the Darzalex regimen will get you a deeper response than pairing CyBorD / VCD with a transplant. The high-dose chemo used in the transplant process is typically high-dose melphalan, and melphalan and cyclophosphamide are in the same class of drugs. You usually get more of a response from a sequence of two drugs if they're from different drug classes (Darzalex and melphalan) rather than similar drugs (cyclophosphamide and melphalan).

Here is a link to the published results of a study looking at Darzalex, Velcade, and dex in relapsed myeloma patients:

http://www.nejm.org/doi/full/10.1056/NEJMoa1606038#t=abstract

Here is a link to a meeting abstract with results of a study looking at CyBorD / VCD in relapsed myeloma patients:

http://ascopubs.org/doi/abs/10.1200/jco.2014.32.15_suppl.8586

This poster for the above meeting abstract can be viewed here:

https://myelomabeacon.org/docs/asco2014/8586.pdf

From what I can tell, however, the patients in the CyBorD / VCD study had more prior therapies than those in the Darzalex, Velcade, and dexamethasone study.

Good luck with your decision. I hope you respond well to whichever regimen you and your doctors choose to pursue.