Dr. Nathwani on the Standard of Care in Patients With Newly Diagnosed Multiple Myeloma

Nitya Nathwani, MD, assistant clinical professor, Hematology and Hematopoietic Cell Transplantation, City of Hope, discusses the standard of care in patients with newly diagnosed multiple myeloma.

In the United States, lenalidomide (Revlimid), bortezomib (Velcade), and dexamethasone (RVd) is considered the standard of care in patients with newly diagnosed multiple myeloma. There have been studies that have looked at carfilzomib (Kyprolis) in combination with lenalidomide and dexamethasone but there’s an excess of cardiac and pulmonary toxicity in older patients.

The SWOG S7077 study was a large trial that randomized patients to RVd versus lenalidomide and dexamethasone. That trial showed significant prolongation in progression-free survival and overall survival in the RVd arm. That study has established RVd as the standard of care. However, not all patients are able to tolerate full-dose RVd, so it should be dose reduced as appropriate, states Nathwani.