The VAD regimen has long been used for myeloma. It includes infusional Adriamycin but a newer drug, Doxil, may replace it. A multi-center trial is ongoing involving over 200 patients, comparing Doxil, Vincristine, and decadron (DVd) versus Vincristine, Adriamycin, and Dexamethasone (VAD). DVD is faster, does not require a prolonged infusion and is less cardiotoxic; it is more cost effective. It is supported by phase II trials and has been widely adopted in the place fo VAD.
A recent study found aratumumab, bortezomib, and dexamethasone to be superior, but the DVD regimen is still widely used.
Mateos MV, Estell J, Barreto W, et al. Efficacy of daratumumab, bortezomib, and dexamethasone versus bortezomib and dexamethasone in relapsed or refractory myeloma based on prior lines of therapy: Updated analysis of CASTOR. Paper presented at: American Society of Hematology (ASH) 58th Annual Meeting and Exposition; December 3-6, 2016; San Diego, CA.
NCCN, Myeloma 2018
Rajkumar SV, Dispenzieri A. Multiple myeloma and related disorders. In: Niederhuber JE, Armitage JO, Doroshow JH,. Kastan MB, Tepper JE. Abeloff’s Clinical Oncology. 5th edition. Philadelphia, PA. Elsevier: 2014:1991-2017.