In a nutshell
This study compared a combination therapy of carfilzomib (Kyprolis), lenalidomide (Revlimid), dexamethasone (Decadron), and cyclophosphamide (Cytoxan) to control combination therapies as an alternative treatment regimen in newly diagnosed patients with multiple myeloma (MM).
The authors concluded that this regimen provided very good responses and was well tolerated in these patients.
Some background
MM is a cancer that comes from blood cells called plasma cells. There are many treatments available. However, many of these therapies have a high risk of side-effects. Carfilzomib is a targeted therapy that blocks the activation of some proteins in MM cells. This causes MM cells to stop growing and die. It is used to treat relapsed MM. Combined with other tretaments, carfilzomib has proven promising. Lenalidomide and dexamethasone are standards treatments for MM. Cyclophosphamide works as a chemotherapy and to suppress the immune system and is also commonly used in MM.
After induction (first time) treatments that kill cancer cells, patients may receive an autologous stem cell transplant (ASCT). This involves taking healthy stem cells from the patient and reinfusing them back after treatment to replace damaged plasma cells.
The safety and effectiveness of the combination between carflizomib, lenalidomide, dexamethasone, and cyclophosphamide (KRdc) before ASCT in patients with newly diagnosed MM are still unknown.
Methods & findings
This study recruited 1,056 newly diagnosed patients with MM. Patients were randomly assigned to receive either KRdc (526) or a control standard therapy for MM (530). Control therapies included lenalidomide, dexamethasone, and cyclophosphamide (Rdc; 265) or thalidomide (Thalomid), dexamethasone, and cyclophosphamide (Tdc; 265). Patients went on to have an ASCT, followed by either observation or a lenalidomide maintenance treatment. Maintenance treatment aims to prevent cancer relapse or delay progression. The average follow-up was 34.5 months.
During follow-up, 32.5% of the KRdc group and 45.3% of the control groups experienced disease progression. The KRdc regimen was associated with a 37% lower risk of disease progression compared to controls. In patients aged over 65 years, KRdc was associated with a 55% lower risk of disease progression compared to controls.
At the end of treatment, no cancer cells were detected in 55% of the KRdc group compared to 17% in the control group. Also, more patients in the KRdc group were able to have ASCT (74.9%) compared to control group (63.8%). KRdc treatment was associated with a 25% reduction in the mortality risk compared to the control treatments.
Sde-effects were reported in 69.5% of patients in the KRdc group compared to 55.3% in the control groups. Most of these side effects involved infections.
The bottom line
The authors found that KRdc was a safe, effective and suitable treatment regimen for newly diagnosed, transplant-eligible patients with MM.
The fine print
Investigators and patients knew which treatment they had been given. This may have affected patient outcomes.
Published By :
Plos Medicine
Date :
Jan 01, 2021
