How useful is a carfilzomib, bendamustine, and dexamethasone treatment combination for hard-to-treat multiple myeloma?

This study reported the safety and effectiveness of a combination of carfilzomib (Kyprolis), bendamustine (Treanda), and dexamethasone (Decadron) for patients with relapsed or refractory (r/r) multiple myeloma (MM). The data showed that a combination of carfilzomib, bendamustine, and dexamethasone (CBd) showed promising effectiveness in these patients. 

MM is a cancer of mature plasma cells. During recent years, new treatment options were developed for MM including immunomodulatory drugs (IMiDs), proteasome inhibitors (PIs) such as carflizomib, and monoclonal antibodies (mAbs). However, chemotherapy drugs such as bendamustine also provide an important treatment option. Additionally, corticosteroids like dexamethasone are used for inflammation control.

Studies based on a bendamustine and carfilzomib combination were already done in patients with newly diagnosed MM. However, the safety and effectiveness of a carfilzomib, bendamustine, and dexamethasone (CBd) treatment combination in patients with r/r MM are still under investigation.

This study included 17 patients with r/r MM, previously treated with one or more lines of therapy. Patients received increasing doses of carfilzomib and bendamustine and 20 mg of dexamethasone. The dose of bendamustine was established at 70 mg/m², while for carfilzomib was 20/36 mg/m². Patients were followed up for an average of 56.7 months.

88% of patients responded to treatment. Of these, 53% had a very good partial response (tumor disappearance or shrinkage). The average duration of response was 14.8 months. 94% of patients had tumor shrinkage or stable disease (tumors do not grow or spread). The average survival without cancer worsening was 15.1 months.

The most common severe side effects were low blood cell counts, infections, and tiredness.

The authors concluded that the combination of carfilzomib, bendamustine, and dexamethasone showed promising safety and effectiveness for patients with r/r MM.

The study included a very small number of patients and was of short duration. Larger studies are needed.