A recent phase II trial has demonstrated that ongoing administration of daratumumab, bortezomib, and dexamethasone (DVd) significantly benefits patients undergoing second-line treatment for relapsed or refractory multiple myeloma (MM). The study, conducted across ten centers in Korea, highlights the potential of a continuous DVd regimen to improve patient outcomes.
Study Design and Methodology
The trial (KCT0004352) enrolled 26 patients with MM who were receiving DVd therapy as a second-line treatment. Treatment protocols included weekly and bi-weekly doses of daratumumab and bortezomib, respectively, alongside dexamethasone. Following nine cycles, patients continued with daratumumab and bortezomib until disease progression or unacceptable side effects emerged. The primary focus was on achieving a very good partial response (VGPR), with secondary measures assessing progression-free survival (PFS), overall survival (OS), safety, and minimal residual disease (MRD) negativity.
Key Findings and Outcomes
Results revealed that 65% of patients attained VGPR or better, and 23% achieved MRD negativity. The median PFS stood at 21.8 months, while the OS rate at 24 months reached 69.2%. Adverse effects included grade 3 thrombocytopenia and lymphopenia, with 31% experiencing serious adverse events and 65% requiring dose adjustments.
- Continuous DVd regimen shows higher VGPR rates compared to fixed-duration therapy.
- Prolonged PFS suggests sustained disease control with continuous treatment.
- Manageable toxicity profiles support the feasibility of long-term DVd use.
The study’s findings indicate that extending bortezomib administration beyond the traditional fixed duration can enhance treatment efficacy without compromising safety. This approach addresses previous limitations associated with fixed-dose regimens, offering a more robust strategy for managing relapsed or refractory MM.
Safety profiles remained acceptable, with manageable adverse events that were effectively controlled through dose modifications. The high rate of VGPR and significant PFS improvement underscore the clinical benefits of continuous DVd therapy in the second-line setting.
Healthcare providers may consider adopting continuous DVd regimens for eligible MM patients, given the promising response rates and survival outcomes observed. Further research with larger cohorts could solidify these findings and potentially establish new standards for MM treatment protocols.
Implementing continuous DVd therapy could lead to enhanced quality of life and prolonged survival for MM patients, marking a significant advancement in the therapeutic landscape of multiple myeloma.
Extending the duration of bortezomib in the DVd regimen not only improves response rates but also offers a sustainable treatment option with manageable side effects. This strategy represents a meaningful progression in second-line MM therapy, providing patients with more effective and enduring treatment options.
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