Myeloma Treatment Comparison: RVd vs. D-RVd Outcomes | Nisha Joseph, MD | ASH 2023

Hi, my name is Nisha Joseph. I'm an assistant professor in the Plasma Cell Disorders Group at Winship Cancer Institute of Emory University. And this year, our group was fortunate to present our data, a comparative analysis between newly diagnosed transplant eligible myeloma patients who were induced with RVD versus deritumumab with RVD. And so our group has already published on a group of 1,000 newly diagnosed patients who were treated with RVD induction between 2007 and 2016. And what we found was really unprecedented and impressive, both depth of response and long-term survival, with median or average progression-free survival and overall survival that hadn't been reported and really showed and improved, hadn't been reported in a real world population. And really was a testament and showed how much therapies have improved over the last few decades, leading to such significant improved survival in myeloma patients. And so since that time, the Phase II Griffin trial has showed and demonstrated a benefit with the addition of deritumumab, which is a monoclonal anti-CD38 antibody, to this RVD backbone. And we again incorporated derirVD early into our standard of practice. And we now have over 300 patients in our database that have been induced with dara plus RVD, so this quadruplet regimen, compared to the triplet RVD regimen that we had previously been using. And so we wanted to do a comparative analysis looking at our historical RVD cohort versus this newer dara RVD cohort to see if we were in fact obtaining that benefit in the clinical setting that we had been seeing in clinical trials. And what we saw was that exactly that, that the addition of deritumumab, this quadruplet induction regimen, shows improved both depth of response and then PFS, or remission benefit, which we know will hopefully correlate with long-term survival. And I think importantly, another benefit of this data set is that about 40% of the patients in the data set are black, which is representative of the patient population that we treat in Atlanta. And when we look specifically at patients and how they responded to dara RVD versus to white patients who responded to dara RVD, we saw no difference there. And I think that's really important, and that was also reflected in the RVD database, and that's really important because what that is telling us is that if patients have the same access to care, they do just the same long-term. So I think that's really another important take-home message from our data set. And lastly, I think the difference of our data set in comparison to clinical trials is the maintenance approach. So routinely for standard-risk patients, they're continued on lenalidomide maintenance until progression, and high-risk patients are continued on a triplet maintenance regimen with an imid and a proteasome inhibitor. And that's different than the clinical trials ongoing, including the Griffin trial, which is already reported out, as well as the Perseus study, which is to be presented at this meeting. So what our data shows is the role of single-agent lenalidomide maintenance therapy and really raises the question, do we need multi-agent maintenance for all patients? And I think that's something that we must, as a community, continue to investigate and better understand both what is the optimal maintenance strategy for different subtypes of risk and how long that maintenance therapy should be continued.