Elotuzumab, lanalidomide and dexamethasone increases overall survival of patients with relapsed or refractory multiple myeloma.

This trial was carried out to examine the effectiveness and safety of elotuzumab (Empliciti), lenalidomide (Revlimid), and dexamethasone (Decadron) in relapsed or refractory (unresponsive) multiple myeloma (MM). The authors found that there was an improved survival in these patients in the long-term.

Despite the introduction of highly effective front-line therapies, nearly all patients with multiple myeloma (MM) eventually relapse and become refractory to treatment. 5-year OS remains low at around 50%. 

Elotuzumab is an immune protein that is used in the treatment of MM. It activated a protein that can identify and kill MM cells. Lenalidomide is used to enhance the effectiveness of elotuzumab. Dexamethasone is a steroid drug used to reduce inflammation in the body. Previous trials have shown that the combination of elotuzumab, lenalidomide, and dexamethasone (ERd) could improve the outcomes of patients with relapsed or refractory (r/r) MM. Until now, the long-term effectiveness and safety of ERd in patients with r/r MM has not been assessed.

Overall, 635 patients with r/r MM were enrolled in this trial. 318 patients received treatment with ERd and 317 patients received treatment with lenalidomide and dexamethasone (Rd) alone. Before this study, patients had received 1-3 lines of therapy. The average follow-up for this trial was 70.6 months. 

The average overall survival (OS) was 8.7 months longer in the ERd group when compared to the Rd group. The average OS was 48.3 months in the ERd group compared to 39.6 months in the Rd group. 

The survival benefit of ERd vs Rd was seen regardless of age, the number of previous therapies or the category of disease risk.

77% of the ERd group and 68% of the Rd group reported serious side effects. These included infections or pneumonia. 11% of patients in the ERd group experienced infusion reactions. However, most were mild.

The authors found that the addition of elotuzumab to an Rd regimen was effective in prolonging survival in patients with r/r MM. 

This study was supported by Bristol-Meyers Squibb and Abbvie, the manufacturers of elotuzumab. This study was also supported by Celgene, the manufacturers of lenalidomide.