As Revlimid (Lenalidomide Hemihydrate) based chemotherapy enters the benefit, changes in RRMM prescription patterns are inevitable. Kyprolis-centered KRd therapy (Carfilzomib+Revlimid+Dexamethasone) and Ninlaro-centered IRd therapy (
As both Ixazomib+Revlimid+Dexamethasone) contain Revlimid, there are concerns at the clinical site about how to take follow-up prescriptions.

Revlimid's benefit has been reimbursed for RVd therapy (Lenalidomide + Bortezomib + Dexamethasone) and R2 therapy (Lenalidomide + Lituximab) since April. RVd therapy was recommended as the primary treatment for multiple myeloma in the NCCN and ESMO guidelines, but benefits were not applied until April in Korea. For this reason, clinical sites have expressed opinions on the need for benefits of RVd therapy and R2 therapy.

As RVd therapy becomes available for primary treatment, discussions on the use of KRd therapy and IRd therapy, which were prescribed in RRMM, continue

In the case of multiple myeloma, there is a possibility of continuous recurrence, so it is prescribed by taking a different combination of treatments that can be used for each order. It was impossible to prescribe IRd therapy if KRd therapy was used in the past, so a treatment strategy was used to use KD therapy in the next order of treatment after using IRd therapy at the discretion of the medical staff. Experts believe that as RVd therapy is used for primary treatment, the use of KRd therapy and IRd therapy containing Revlimid will also be reduced.

Professor Kim Seok-jin of the Department of Hematology and Oncology at Samsung Medical Center said, "If RVd is used as the primary treatment, KRd and IRd will inevitably be affected." "This benefit is meaningful," he explained.

It is not that IRd therapy cannot be used when RVd therapy is used in primary treatment and KRd therapy on which Rd therapy is based. After diagnosis, multiple myeloma is divided into a "transplant target group" and a "non-transplant target group" depending on whether hematopoietic stem cell transplantation is possible, and Takeda explains that patients can be treated with the same benefit as now after recurrence even if VRD is applied as the primary treatment. The prerequisite is that VRd therapy is transplanted after 6 cycles and recurrence after maintaining the reaction for more than 6 months.

In the case of non-transplantation groups, the use of VRD as Until Progression as primary treatment makes it difficult to apply both R-based treatments, including IRd and KRd, which are currently available for benefit prescriptions, in the second.


#Will it be established as KRd/IRd therapy maintenance therapy in non-transplant patients?

Then, how many patients can use KRd and IRd therapy according to the entry of RVd therapy into primary treatment? Lee Je-joong, a professor of hematology at Hwasun Chonnam National University Hospital, said, "In the group of patients who can be transplanted, RVd is performed for about four cycles and most of them react, so most of the patients can use both KRd and IRd as secondary therapy. In terms of the total number of patients with multiple myeloma, 55% of them can be transplanted, and 90% of them will be able to use KRd and IRd therapy."

There is no significant difference from the previous one in patients who can be transplanted, but experts predict that it will be Kd therapy for Cypriot and maintenance therapy for ninjas as it is difficult to use KRd and IRd in secondary treatment for non-transplant patients. Both options are continuously confirmed through current research to expand indications and confirm their efficacy.

Kd therapy has the result of extending the survival period compared to Vd therapy by another 12 months in RRMM patients who previously received one treatment, including elderly patients, who are the main patients with multiple myeloma.

Since May last year, Kyprolis has obtained additional indications for the dose of Kd once a week in the treatment of RRMM patients, and the fact that both Kd once a week and twice a week are covered by insurance benefits is also expected to have a positive effect.

In addition to IRd therapy, Ninlaro has indications for maintenance therapy for patients who received autologous hematopoietic stem cell transplants and those who did not receive them in March and September last year, respectively. However, in the case of maintenance therapy, it was not reimbursed.