Evaluating Kd and Vd chemotherapy for patients with relapsed or refractory multiple myeloma

This study compared the effectiveness of Kd (carfilzomib, dexamethasone) chemotherapy to Vd (bortezomib, dexamethasone) chemotherapy in patients with multiple myeloma (MM). This study found that Kd improved survival outcomes and had fewer side effects compared to Vd chemotherapy for these patients.

Multiple myeloma is a type of cancer of the bone marrow that can lead to abnormal immune cells. After initial treatment, the cancer may come back (relapse) or become refractory (stop responding to treatment). Patients who receive multiple lines of therapy for refractory disease tend to have poorer outcomes. Treatment remains challenging for these patients.

Carfilzomib and dexamethasone are commonly used together to treat relapsed or refractory MM.  Carfilzomib targets cancer cells without damaging healthy cells. This leads to cancer cell death with fewer side effects. When combined with other anti-cancer drugs, dexamethasone can help kill cancer cells. Whether this combination leads to better long-term outcomes for patients compared to the Vd regimen is under investigation.

This study had 929 patients with relapsed or refractory MM. Patients were either given Kd (464 patients) or Vd (465 patients). On average, patients received 1 to 3 previous lines of therapy. Patients were followed-up for an average of 43.7 to 44.3 months.

Overall, patients who received Kd survived for longer than patients in the Vd group (47.8 months vs. 38.8 months). Kd treatment was significantly associated with 24% higher odds of surviving for more than three years.

In patients who had only one previous treatment, patients in the Kd group had longer survival (51.3 months vs. 43.7 months). With 2 to 3 lines of prior therapy, patients in the Kd group still had longer survival (39.5 months vs. 28.4 months).

In patients with high-risk disease, patients in the Kd group had longer survival (28.0 months vs. 22.7 months) compared to the Vd group. For these high-risk patients, Kd treatment was associated with a 19% lower mortality risk compared to Vd.

Overall, 98.7% (Kd) and 98.9% (Vd) of patients experienced side effects. Serious side effects were reported in 81.9% (Kd) and 71.1% (Vd) of patients. The most common serious side effects were heart failure (6% vs. 2%) and nerve damage (6.9% vs. 34.9%). Serious high blood pressure (14.9% vs. 3.3%) and infections (32.0% vs. 20.6%) were also reported.

More patients in the Kd group stopped treatment due to symptoms of heart failure compared to the Vd group (3.9% vs. 0.9%). 2.4% of patients treated with Kd stopped treatment due to high blood pressure.

This study concluded that Kd chemotherapy improved survival outcomes more than Vd for patients with recurrent or refractory MM. However, patients treated with Kd had more severe side effects.

This study was funded by Onyx, the manufacturer of carfilzomib. More studies are needed to confirm these results.

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