This is an interesting ASH abstract. I wonder if this study might lead to making RVD-Lite into one of the standard RVD regimens in younger, newly diagnosed multiple myeloma patients in the near future. I'm sure most anybody would welcome getting less frequent Velcade injections.
https://myelomabeacon.org/resources/mtgs/ash2015/abs/4217/
Forums
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: RVD Lite
"Modified RVD (“RVD-lite”) was administered over a 35-day cycle. Lenalidomide 15 mg was given on days 1-21; bortezomib 1.3 mg/m2 once weekly subcutaneously (SC) on days 1, 8, 15, and 22; and dexamethasone 20 mg on days 1, 2, 8, 9, 15, 16, 22 and 23 for pts ≤75 yrs "
I am not sure that this is really a "lite" regimine. When I received my induction protocol starting in February 2009, it was: 10 mg of lenalidomide days 1-21; bortezomib 1.3 mg/ms once a week (infusion as SC was not approved then) days 1, 8, 15, 22 and dexamethasone 40 mg days 1, 8, 15, 22 orally.
So mine was actually less than the "lite" regimen as the Revlimid was only 10 mg as opposed to 15 mg. The total dex received per week is the same totaling 40 mg a week. I believe it takes less time to recover from 40 mg once a week than spreading it out by giving back to back 20 mg doses. That however, depends on the individual.
A truly lite regimen would be 5 mg of Revlimid not 15 mg and 20 mg of dex once a week not twice.
My original induction was over 6 years ago. I think that there has been a lot of experimentation with induction treatment by oncologists. Some start heavier, some lighter, depending upon how the patient presents.
I am not sure that this is really a "lite" regimine. When I received my induction protocol starting in February 2009, it was: 10 mg of lenalidomide days 1-21; bortezomib 1.3 mg/ms once a week (infusion as SC was not approved then) days 1, 8, 15, 22 and dexamethasone 40 mg days 1, 8, 15, 22 orally.
So mine was actually less than the "lite" regimen as the Revlimid was only 10 mg as opposed to 15 mg. The total dex received per week is the same totaling 40 mg a week. I believe it takes less time to recover from 40 mg once a week than spreading it out by giving back to back 20 mg doses. That however, depends on the individual.
A truly lite regimen would be 5 mg of Revlimid not 15 mg and 20 mg of dex once a week not twice.
My original induction was over 6 years ago. I think that there has been a lot of experimentation with induction treatment by oncologists. Some start heavier, some lighter, depending upon how the patient presents.
-
Ron Harvot - Name: Ron Harvot
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Feb 2009
- Age at diagnosis: 56
Re: RVD Lite
Hey Ron,
Point taken.
I "believe" that most of the current published RVD dosing schedules call for 1, 4, 8, 11 cycle for the Velcade portion of the cocktail. But it sounds like you had a less frequent Velcade schedule. I think it is probably the reduced Velcade dosing schedule (not the reduction in the dose) that makes this regimen "Lite" in the author's minds.
There is also the issue of semantics when it comes to "low dose" with myeloma treatments, and I think the term "Lite" has this same issue. As an example, at first I thought that "low-dose dex" was generally accepted to be an actual reduction in the amount of dex that is administered in any one given dose. But then I realized that the term "low-dose dex" instead referred to a reduction in the frequency of dex dosing, as well as a reduction in the total dex delivered over a cycle and NOT the amount of an individual dex dose.
https://myelomabeacon.org/forum/dex-dosing-rvd-vrd-t3857.html#p21913
In any case, I agree that a truly "Lite" regimen would ideally be one that reduced both the frequency and the amount of any individual dose during a cycle. But clearly the developers of this "Lite" protocol were trading off efficacy for toxicity as they came up with this regimen.
Point taken.
I "believe" that most of the current published RVD dosing schedules call for 1, 4, 8, 11 cycle for the Velcade portion of the cocktail. But it sounds like you had a less frequent Velcade schedule. I think it is probably the reduced Velcade dosing schedule (not the reduction in the dose) that makes this regimen "Lite" in the author's minds.
There is also the issue of semantics when it comes to "low dose" with myeloma treatments, and I think the term "Lite" has this same issue. As an example, at first I thought that "low-dose dex" was generally accepted to be an actual reduction in the amount of dex that is administered in any one given dose. But then I realized that the term "low-dose dex" instead referred to a reduction in the frequency of dex dosing, as well as a reduction in the total dex delivered over a cycle and NOT the amount of an individual dex dose.
https://myelomabeacon.org/forum/dex-dosing-rvd-vrd-t3857.html#p21913
In any case, I agree that a truly "Lite" regimen would ideally be one that reduced both the frequency and the amount of any individual dose during a cycle. But clearly the developers of this "Lite" protocol were trading off efficacy for toxicity as they came up with this regimen.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: RVD Lite
Multibilly,
It would be interesting to hear what other patients had for an intitial RVD protocol.
PN has been a big issue with RVD. Going to subcutaneous (SC) as opposed to infusion has helped. However, high dosage of Revlimid at 25 mg is a contributor to PN. I wonder if a 10 mg or even 5 mg of Revlimid would prove as effective but with less toxicity.
The same is true with going to lower dosing of dex. If 40 mg a week is better than 80 a week, then what happens when it is reduced to 20 mg a week? Does lowering the dosage really have a negative effect on outcome?
I suspect it varies with how the patient presents. Start low, work high if results are not showing, or start high and back down as results are achieved or toxicity is too great.
Ron
It would be interesting to hear what other patients had for an intitial RVD protocol.
PN has been a big issue with RVD. Going to subcutaneous (SC) as opposed to infusion has helped. However, high dosage of Revlimid at 25 mg is a contributor to PN. I wonder if a 10 mg or even 5 mg of Revlimid would prove as effective but with less toxicity.
The same is true with going to lower dosing of dex. If 40 mg a week is better than 80 a week, then what happens when it is reduced to 20 mg a week? Does lowering the dosage really have a negative effect on outcome?
I suspect it varies with how the patient presents. Start low, work high if results are not showing, or start high and back down as results are achieved or toxicity is too great.
Ron
-
Ron Harvot - Name: Ron Harvot
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Feb 2009
- Age at diagnosis: 56
Re: RVD Lite
I agree it would be great to hear from folks on the forum on what their RVD dosing schedules and dose amounts were at induction.
I suspect that there are multiple myeloma specialists (perhaps like yours) that either start off with a non-standard RVD regimen and/or quickly adjust things based on a patient's response and/or side effects (this is the kind of multiple myeloma alchemist I want in my corner). But I also suspect that there are quite a few folks that get treated with RVD and their doctors simply use a standard RVD "cookbook" regimen throughout the entire induction cycle - especially if their treating doctor is not a myeloma specialist. So, if kinder and gentler RVD regimens made it into the myeloma treatment cookbooks, then more patients could benefit from it.
But these are just suspicions on my part, and I'm not basing these comments on any data.
I suspect that there are multiple myeloma specialists (perhaps like yours) that either start off with a non-standard RVD regimen and/or quickly adjust things based on a patient's response and/or side effects (this is the kind of multiple myeloma alchemist I want in my corner). But I also suspect that there are quite a few folks that get treated with RVD and their doctors simply use a standard RVD "cookbook" regimen throughout the entire induction cycle - especially if their treating doctor is not a myeloma specialist. So, if kinder and gentler RVD regimens made it into the myeloma treatment cookbooks, then more patients could benefit from it.
But these are just suspicions on my part, and I'm not basing these comments on any data.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: RVD Lite
I was diagnosed with Stage 3, high-risk kappa light chain myeloma at the end of July, 2015.
My initial treatment regimen is Revlimid 25 mg days 1-14, off 22-28. Velcade, 1.3 mg/m2 once/week sub-q, 20 mg dexamethasone once/week. Zometa infusion every 4 weeks.
The plan is for 5-6 cycles before starting stem cell harvesting procedure at the end of the year.
Side effects have been minimal. I get tired more easily and often experience insomnia on dexamethasone dose days.
My initial treatment regimen is Revlimid 25 mg days 1-14, off 22-28. Velcade, 1.3 mg/m2 once/week sub-q, 20 mg dexamethasone once/week. Zometa infusion every 4 weeks.
The plan is for 5-6 cycles before starting stem cell harvesting procedure at the end of the year.
Side effects have been minimal. I get tired more easily and often experience insomnia on dexamethasone dose days.
-
Bikeman48088 - Name: Mark
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: July 2015
- Age at diagnosis: 58
Re: RVD Lite
Perhaps I misunderstand but, aside from the dosing, which does vary some especially if the patient experiences side effects, I think the difference is that lite is on a 35-day schedule while regular RVD is on a 28-day cycle. So it looks like there is a break from the Velcade and dex, and two weeks off from Revlimid.
-
goldmine848 - Name: Andrew
- When were you/they diagnosed?: June 2013
- Age at diagnosis: 60
Re: RVD Lite
Andrew,
You are right. Most of the standard protocols call for Revlimid 21 days on, 7 days off. Since this is a 35 day regimen and it is on for 21 days, it must be off for 14 not 7. The Velcade is the same two weeks off - on once a week for 4 weeks then off 2 weeks. I did not pick up on that earlier.
You are right. Most of the standard protocols call for Revlimid 21 days on, 7 days off. Since this is a 35 day regimen and it is on for 21 days, it must be off for 14 not 7. The Velcade is the same two weeks off - on once a week for 4 weeks then off 2 weeks. I did not pick up on that earlier.
-
Ron Harvot - Name: Ron Harvot
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Feb 2009
- Age at diagnosis: 56
Re: RVD Lite
Andrew,
Nice catch. I wasn't thinking in those terms either.
Nice catch. I wasn't thinking in those terms either.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: RVD Lite
Also, when I did RVD, Velcade and dex were once a week with no breaks.
-
goldmine848 - Name: Andrew
- When were you/they diagnosed?: June 2013
- Age at diagnosis: 60
12 posts
• Page 1 of 2 • 1, 2