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A four-drug anti-myeloma combination consisting of pegylated liposomal doxorubicin, bortezomib, dexamethasone, and lenalidomide. Mechanistically, it pairs an anthracycline topoisomerase II inhibitor delivered in a pegylated liposome (pegylated liposomal doxorubicin) with a proteasome inhibitor (bortezomib), an immunomodulatory agent (lenalidomide), and a corticosteroid (dexamethasone). The regimen integrates complementary cytotoxic, proteasome-inhibitory, immunomodulatory, anti-angiogenic, and anti-inflammatory effects to enhance depth and duration of responses in multiple myeloma. Clinical evidence supports subsets of these components: pegylated liposomal doxorubicin combined with bortezomib improves time to progression versus bortezomib alone in relapsed/refractory multiple myeloma; lenalidomide plus dexamethasone is established therapy; and bortezomib + lenalidomide + dexamethasone (VRd/RVd) is a standard frontline triplet. This four-drug combination is used as an intensified regimen or in clinical investigations for multiple myeloma.
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