Saad Z. Usmani, MD, MBA, FACP, discusses the use of lenalidomide, bortezomib, and dexamethasone with or without elotuzumab for newly diagnosed, high-risk multiple myeloma.
At the2022 American Society of Clinical Oncology (ASCO) Annual Meeting, Saad Z. Usmani, MD, MBA, FACP, chief of the Myeloma Service at Memorial Sloan Kettering Cancer Center in New York, spoke with CancerNetwork® about the phase 1/2 SWOG 1211 trial (NCT01668719) which analyzed lenalidomide (Revlimid), bortezomib (Velcade), dexamethasone (RVd) with or without elotuzumab (Empliciti) in patients with newly diagnosed high-risk multiple myeloma. While the results of the trial were negative, they did show the potential of proteasome inhibitors and immunomodulatory drugs as induction and maintenance for this population.
The median progression-free survival in the elotuzumab plus RVd arm was 29.37 months vs 33.64 months in the RVd-alone arm (HR, 1.11; 80% CI, 0.82-1.49; P = .66). The difference in median overall survival was not statistically significant and was not reached in the elotuzumab arm vs 68.34 months in the RVd-alone arm (HR, 0.85; 80% CI, 0.59-1.23; P = .58).
SWOG 1211 was a first of its kind study that was designed by [SWOG in the National Cancer Institute clinical trials cooperative group]. Back in the early 2010s, there was an initiative within the cooperative groups to develop a different treatment strategy for [patients with] high-risk multiple myeloma in the newly diagnosed setting. That’s where the SWOG 1211 concept came from. It was an enrichment design clinical trial to see if we can establish some guiding post on how to treat [patients with] high-risk myeloma.
We were worried we wouldn’t be able to accrue patients to a study of this nature, but it accrued in record time ahead of schedule. The study was designed with RVd as induction followed by RVd as dose-attenuated maintenance in the experimental arm, and the SLAMF7 antibody elotuzumab was added to that schema. Addition of elotuzumab did not improve responses or progression-free or overall survival, so the study is negative. The concept of giving combination chemotherapy induction followed by combination chemotherapy maintenance helped achieve a median PFS of 34 [months] in the RVd arm. Even though there were no differences, looking at what was being reported historically for [patients with high-risk disease shows] an improvement. The other important lesson that we can learn from this study are how to plan and conduct trials in the high-risk setting, and there are other trials being reported now at ASCO where single-arm studies are looking only at [patients who are] high risk.
Usmani SZ, Hoering A, Ailawadhi S, et al. Randomized phase II trial of bortezomib, lenalidomide, dexamthasone with/without elotuzumab for newly diagnosed, high risk multiple myeloma (SWOG-1211). J Clin Oncol. 2022;40(suppl 16):8054. doi: 10.1200/JCO.2022.40.16_suppl.8054