DRd Shows Longer Time-to-Next-Treatment vs VRd in Myeloma


Doris Hansen, MD, discusses the efficacy of daratumumab, lenalidomide, and dexamethasone vs bortezomib, lenalidomide, and dexamethasone in newly diagnosed myeloma.

Doris Hansen, MD, assistant member, Moffitt Cancer Center department of blood and marrow transplant and cellular immunotherapy, discusses the efficacy of daratumumab (Darzalex), lenalidomide (Revlimid), and dexamethasone (DRd) compared with bortezomib (Velcade), lenalidomide, and dexamethasone (VRd) in newly diagnosed myeloma.


0:09 | I presented a comparison of time-to-next-treatment or death between patients treated with frontline daratumumab, lenalidomide and dexamethasone or bortezomib, lenalidomide, dexamethasone in transplant-ineligible patients with newly diagnosed myeloma.

0:27 | Essentially, the objective of the study was to look at the comparative effectiveness between these 2 treatments. There have been no randomized, controlled clinical trials that compare them head-to-head, so we intend to look at these treatments, or the efficacy of this treatment, specifically the time-to-next-treatment or death, using an…database, which does have extensive information on medications, orders fills, medication administration, which made it a perfect database for the purposes of time-to-next-treatment calculation. The type of methodology used was an accepted methodology known as the inverse probability of treatment waiting to adjust baseline characteristics between the groups.

1:11 | Essentially, we had 643 eligible patients in the study. We had 302 weighted patients in the DRd cohort, and 341 weighted patients in the VRd cohort. Overall, baseline characteristics were fairly similar between the 2 groups. There were some minor imbalances in age, race, and index year; however, these are adjusted for in a doubly robust Cox model.

1:37 | In terms of results, we found that frontline daratumumab, lenalidomide, and dexamethasone were associated with a longer time-to-next-treatment or death. It had a 42% lower likelihood of progressing to another therapy or dying, and the median time-to-next-treatment was 38 months with DRd and 19 months with VRd. Our study certainly has limitations as this was a retrospective database. There is some administrative censoring, and we are missing a few variables. Time-to-next-treatment is not a direct proxy for [progression-free survival], but overall, it does support the existing evidence supporting the use of DRd over VRd, and hopefully will assist clinicians and informed decision making when treating patients in this clinical setting.

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