Posted: Wednesday, February 15, 2023
For patients with newly diagnosed multiple myeloma who have received treatment with an induction regimen and autologous stem cell transplantation (ASCT), combination maintenance therapy with carfilzomib, dexamethasone, and lenalidomide (KRd) may improve progression-free survival, according to the phase III ATLAS trial, published in The Lancet Oncology. However, a prolonged follow-up to assess the efficacy of this combination therapy is warranted, explained Andrzej J. Jakubowiak, MD, PhD, of the University of Chicago Medicine Comprehensive Cancer Center, and colleagues.
“Overall, the efficacy and toxicity results of this study indicate a favorable therapeutic index, making KRd a compelling consideration for post-transplant treatment after [ASCT],” stated Dr. Jakubowiak in a University of Chicago press release.
From 2016 to 2020, a total of 180 patients with newly diagnosed multiple myeloma were enrolled in the study. All patients had completed induction therapy and received ASCT within 100 days of the completion of induction therapy. Patients were randomly assigned to receive KRd or lenalidomide alone. Patients in the KRd treatment group were further stratified to receive either 8 or 36 cycles of treatment, based on their individual risk of disease progression. Both KRd cycles were followed by maintenance therapy with lenalidomide alone.
At a median follow-up of 33.8 months, the findings revealed a 49% decrease in patients’ progression-free survival (59.1 months with KRd vs. 41.6 months with lenalidomide alone, hazard ratio = 0.51). Patients who received KRd treatment experienced increased rates of toxicity compared with the lenalidomide-alone group.
Common grade 3 and 4 adverse effects included neutropenia (48% vs. 60%), thrombocytopenia (13% vs. 7%), and lower respiratory tract infections (8% vs. 1%), respectively. Moreover, 30% of patients in the KRd group and 22% of patients in the lenalidomide group experienced serious adverse events.
Disclosure: For full disclosures of the study authors, visit thelancet.com.