Bortezomib, lenalidomide, and dexamethasone (VRd) improve clinical outcomes over lenalidomide and dexamethasone alone (Rd) among patients with newly diagnosed multiple myeloma, according to a study published in The Lancet.1

The current front-line regimen for patients with newly diagnosed myeloma for whom immediate stem cell transplantation is not planned is Rd. Noting the synergistic mechanisms of action of lenalidomide and bortezomib, researchers conducted a phase 3 trial (SWOG S0777; Identifier: NCT00644228) comparing progression-free survival, overall survival, and response rates among patients randomized to receive Rd or VRd.

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Five hundred and twenty-five patients were assigned to receive Rd or VRd; after randomization, 230 patients and 242 patients were deemed eligible to receive Rd and VRd, respectively. Median progression-free survival was 43 months in the VRd group vs 30 months in the Rd group; median overall survival was 75 months vs 64 months, respectively.

Among evaluable patients, recorded partial or better response rates were 82% with VRd and 72% with Rd.

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Eighty-two percent of patients treated with VRd had grade 3 or 4 adverse events; there were 2 treatment-related deaths in this group. Seventy-five percent of patients treated with Rd had a grade 3 or 4 adverse event.

While there were, according to the study’s authors, several limitations, including that age was not a stratification factor and that patients with impaired renal or bone marrow function were excluded, it was concluded that VRd may be an effective front-line treatment for patients with multiple myeloma.


  1. Durie BG, Hoering A, Abidi MH, et al. Bortezomib with lenalidomide and dexamethasone versus lenalidomide and dexamethasone alone in patients with newly diagnosed myeloma without intent for immediate autologous stem-cell transplant (SWOG S0777): a randomised, open-label, phase 3 trial. Lancet. 2016 Dec 22. doi: 10.1016/S0140-6736(16)31594-X [Epub ahead of print]