CancerConnect News: The addition of Kyprolis® (carfilzomib) to the standard treatment regimen, Revlimid® (lenalidomide) and dexamethasone, improves survival for patients with multiple myeloma whose disease progressed or recurred following prior therapies. These results were recently presented at the 2017 annual meeting of the American Society of Hematology (ASH).
About Multiple Myeloma
In the United States alone, approximately 30,000 people will be diagnosed with multiple myeloma in the year 2017. Multiple myeloma is a type of cancer that starts in immune cells called plasma cells. Treatment varies according to the extent or aggressiveness of the disease, as well as the patient’s other existing medical conditions or ability to tolerate some types of therapies.
Patients with multiple myeloma that has recurred following prior therapy have historically been considered incurable. Fortunately, the recent progress of individualized treatment approaches continues to delay the time to cancer progression for these patients.
Kyprolis and bortezomib are both agents that are categorized as proteasome inhibitors. Proteasomes are naturally occurring components in cells that aid in the breakdown and removal of abnormal or unneeded proteins. Proteasome inhibitors interfere with the ability of proteasomes to remove these abnormal proteins, leading to the excessive accumulation and build-up of these proteins within cells, which results in the blocking of normal cellular functions.
Kyprolis is currently approved by the United States Food and Drug Administration (FDA) to be used in combination with dexamethasone alone, or eRevlimid and dexamethasone among patients with multiple myeloma who have received 1-3 prior therapies. It is also approved for use as a single agent for patients with multiple myeloma who have received at least one prior therapy for their disease. Bortezomib is an older proteasome inhibitor also approved for the treatment of multiple myeloma.
Researchers recently reported survival results from a large, international clinical trial referred to as the ASPIRE trial. The ASPIRE trial directly compared two treatment regimens among patients with multiple myeloma who had received 1-3 prior therapies. One group of patients was treated with Kyprolis/Revlimid/dexamethasone (KRd) and the second group was treated with lenadlidomide/dexamethasone (Rd)
- Among patients who had received only one prior therapy that included bortezomib, overall survival was improved by one year (12 months) in the group treated with KRd, compared with those treated with Rd.
- Among patients who had received only one prior therapy that did not include bortezomib, overall survival was improved by 7.9 months in the group treated with KRd, compared to those treated with Rd.
- Among patients who received two or more prior therapies, overall survival was improved by 6.5 months in the group treated with KRd, compared to those treated with Rd.
- Patients who were considered to be at a low risk of developing a recurrence based on specified disease characteristics had not yet reached median survival time for the group treated with KRd had not yet been reached at the time data was collected, and was 58 months for those treated with Rd.
- Patients who were considered to be at an average risk of developing a recurrence had a median overall survival of 45.4 months if treated with KRd, and 41.2 months for those treated with Rd.
- Patients who were considered to be at a high risk of developing a recurrence had a median overall survival 23.3 months for those treated with KRd and 18.8 months for those treated with Rd.
- Discontinuation of treatment, side effects from treatment, and deaths related to treatment occurred at similar rates among patients treated with KRd and those treated with Rd.
The researchers concluded that treatment with “KRd demonstrated a statistically significant and clinically meaningful” reduction in the risk of death among patients with recurrent multiple myeloma, and that “KRd should be considered a standard of care” for patients with this disease. Although Kyprolis is already approved for his indication, these results provide confirmatory data regarding survival benefit with the use of KRd.
Reference: Stewart K, Siegel D, Ludwig H, et al. Overall survival (OS) of patients with relapsed/refractory multiple myeloma (RRMM) treated with Kyprolis, Revlimid, and dexamethasone (KRd) versus Revlimid and dexamethasone (Rd): Final analysis from the randomized phase 3 Aspire trial. Proceedings from the 2017 annual meeting of the American Society of Hematology (ASH). Abstract #743. Retrieved from https://ash.confex.com/ash/2017/webprogram/Paper102318.html
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