Improved survival with carfilzomib lenalidomide and dexamethasone

This paper compared the effect of carfilzomib (Kyprolis), lenalidomide (Revlimid), and dexamethasone (Ozurdex) to lenalidomide plus dexamethasone in patients with relapsed or refractory multiple myeloma. The addition of carfilzomib was associated with a longer survival. 

Multiple myeloma is a cancer of the plasma cells of the blood. Chemotherapy is a standard treatment for multiple myeloma. After initial treatment, many patients have a relapse (return of cancer) or are refractory (do not respond to treatment). Multiple myeloma is not curable. Thus the aim of treatment is to prolong overall survival. Initial analysis of the study found that adding carfilzomib to lenalidomide plus dexamethasone improved survival.

This study reports the full analysis of the results. 

Patients with relapsed or refractory multiple myeloma were studied. 396 patients received carfilzomib, lenalidomide and dexamethasone. 396 patients received lenalidomide plus dexamethasone alone. Patients were followed-up for an average of 67.1 months.

The average overall survival (time from treatment until death from any cause) was 48.3 months among patients who received carfilzomib. The average overall survival was 40.4 months among patients who did not receive carfilzomib. In patients who had received one prior line of therapy, the average overall survival was 11.4 months longer for those who had received carfilzomib. The overall survival with carfilzomib was also improved whether or not patients were more than 75 years old. 

The average survival without worsening disease was 26.1 months in patients who received carfilzomib. The average survival without worsening disease was 16.6 months in patients who did not receive carfilzomib.

19.9% of patients who received carfilzomib stopped treatment because of adverse events (undesired effect of treatment). 21.5% of patients who did not receive carfilzomib stopped treatment because of adverse events. The most common adverse events were cough and low levels of potassium. The rate of adverse events was similar between both groups of patients. 

The authors concluded that the overall survival is longer for patients who receive carfilzomib, lenalidomide and dexamethasone, compared to lenalidomide and dexamethasone alone.