SWOG 1211 Shows Longer Efficacy Than Historical Data for Multiple Myeloma

Saad Z. Usmani, MD, division chief of the Plasma Cell Disorders Program and director of Clinical Research in Hematologic Malignancies at the Levine Cancer Institute, Atrium Health, discusses the phase 2 SWOG 1211 trial investigating bortezomib (Velcade), lenalidomide (Revlimid), and dexamethasone (RVd) with or without elotuzumab (Empliciti) for patients with newly diagnosed, high-risk multiple myeloma.

The primary end point for SWOG 1211 was progression-free survival (PFS). Usmani says the assumption for this study was the RVd arm would have a PFS of about 2 years based on previous data, and the PFS would be improved to 3.5 years with the addition of elotuzumab.

After a median follow-up of 53 months, the primary end point was not met, according to Usmani. Both arms had a similar median PFS, with 34 months for patients on RVd and 31 months for patients receiving RVd plus elotuzumab. Overall survival and overall response rate did not have differences in the 2 groups either. There were higher grade 3 toxicities, such as infection rates and neuropathy, observed in the elotuzumab arm.

The investigators were surprised to see that both arms did better compared with historical data, even in patients who had tandem transplants on total therapy. The median PFS was 26 months in the previous studies looking at this regimen. Usmani says it was concluded that although the trial did not reach its primary end point, it makes a strong case for proteasome inhibitor immunomodulatory drug-based therapy model for patients with high-risk multiple myeloma.

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