Do you continue bortezomib past 8 cycles for transplant ineligible patients with multiple myeloma on VRd who are tolerating therapy well with no neuropathy?

Excellent question without a clear answer. While several RCTs have looked at post-induction maintenance among patients without planned transplantations, the British Myeloma XI trial is the biggest RCT (to my knowledge) to clearly look at lenalidomide vs observation in transplant-ineligible patients....

Yes, I would continue with Vand R as long as they are tolerated. I often change the V to every other week past the initial 8 cycles.

When it comes to maintenance, I am more of a purist in terms of following the protocol as was done in the clinical trials. Therefore, I typically discontinue bortezomib after 8 cycles for transplant-ineligible patients, particularly to avoid neuropathy and myelosuppression. One could also rechalleng...