Dr. Voorhees on Managing TRAEs for Patients With Multiple Myeloma

Peter Voorhees, MD, hematology, medical oncology, Carolinas HealthCare System, discusses optimal management of treatment-related adverse events (TRAEs) for patients with multiple myeloma.

Data from a SWOG study showed that the addition of bortezomib (Velcade) to a lenalidomide (Revlimid)/dexamethasone doublet significantly increases toxicity; peripheral neuropathy is a significant concern in these patients, Voorhees explains. The use of subcutaneous bortezomib will help lower the risk of neuropathy. Additionally, many physicians have started moving toward a modified RVd (lenalidomide, bortezomib, and dexamethasone)—type platform for older patients who may be more prone to these AEs.

For patients 75 years of age or older, or for patients with brittle diabetes or congestive heart failure, Voorhees says he is more likely to use a 20-mg dose of dexamethasone as opposed to a 40-mg dose. This allows researchers to adjust the schedule and mode of administration with regard to bortezomib.