New proof helps the usage of a 3 drug combo—carfilzomib, lenolidomide, and dexamethasone (KRd), for upkeep remedy after autologous stem cell transplantation in sufferers newly identified with a number of myeloma. Upkeep remedy utilizing these three medication might enhance progression-free survival as in comparison with single agent lenalidomide therapy.
After nearly 34 months within the research, median progression-free survival for the KRd arm was 59.1 months in comparison with 41.6 months for the lenalidomide arm. That is a 49% discount within the danger of development or loss of life. This discount was regardless of a shorter length (8 cycles) of therapy in 44% sufferers on the KRd arm.
Researchers from the College of Chicago Drugs Complete Most cancers Middle and colleagues from the Polish Myeloma Consortium report the outcomes, from the continuing ATLAS trial, this month in Lancet Oncology. The research was led by Dominik Dytfeld, MD, PhD.
Total, efficacy and toxicity outcomes had been favorable, making KRd a compelling consideration for post-transplant therapy after autologous stem-cell transplantation, mentioned Andrzej Jakubowiak, MD, PhD, the Director of the Myeloma Program on the College of Chicago and the general Principal Investigator of the ATLAS research.
A number of myeloma is brought on by rogue plasma cells producing a monoclonal immunoglobulin. These cells proliferate within the bone marrow and may trigger osteolytic lesions, osteopenia, and fractures. Sufferers are categorized with standard-risk to high-risk illness based mostly on fluorescence in situ hybridization (FISH) and different exams.
Remedy regimens are based mostly on the stage of the illness. These whose situation is most severe are candidates for autologous hematopoietic cell transplantation. Previous to transplantation, they underwent “induction remedy,” the aim of which is to cut back the variety of rogue plasma cells previous to the process. The subsequent step after the transplant is upkeep remedy.
However, “Lots of the most well-liked therapy choices haven’t been in contrast straight with one another in a randomized trial in these affected person populations. As such, there isn’t any customary of care and completely different specialists use completely different regimens,” notes UpToDate in its newest submit on a number of myeloma therapy.
In consequence, varied regimens and methods to information their use are presently being evaluated in quite a lot of ongoing randomized trials, together with ATLAS—a part 3 medical research being performed at 12 tutorial and medical facilities in america and Poland.
Between June 2016 and October 2020, this research enrolled 180 sufferers who had been randomly assigned to obtain both KRd or lenalidomide alone. Eligibility standards included the completion of transplantation with no development inside twelve months from begin of pre-transplantation remedy.
The KRd arm acquired both 8 or 36 cycles of KRd therapy based mostly on minimal residual illness standing and different dangers for development. Sufferers with customary danger illness who achieved MRD-negativity on the finish of 6 cycles of KRd upkeep, acquired a complete 8 cycles of KRd adopted by lenalidomide upkeep. The remaining sufferers continued KRd for 36 cycles adopted by lenalidomide upkeep.
The first endpoint of the research was progression-free survival and secondary endpoints included MRD-negativity charges, security, and tolerability.
Investigators observe that these interim outcomes are in step with these from the part 2 FORTE trial, printed in The Lancet in 2021. That research reported an enchancment in progression-free survival, within the upkeep part of the trial, with addition of carfilzomib to lenalidomide compared with lenalidomide alone.