Are Carfilzomib-Based Regimens Safe and Effective for Frail Patients With Myeloma?
Posted: Friday, December 11, 2020
According to research published in Blood Advances, carfilzomib-based treatment regimens may be appropriate for patients with relapsed or refractory multiple myeloma who have been classified as frail. Meletios A. Dimopoulos, MD, of the National and Kapodistrian University in Athens, and colleagues analyzed results from a set of phase III studies—ASPIRE, ENDEAVOR, and ARROW—which indicate that both lenalidomide-containing and lenalidomide-sparing regimens are safe and efficacious for this patient population.
The ASPIRE, ENDEAVOR, and ARROW studies included 196, 330, and 141 frail patients, respectively. The ASPIRE study compared carfilzomib (27 mg/m2), lenalidomide, and dexamethasone (KRd27) and lenalidomide plus dexamethasone; the ENDEAVOR study compared carfilzomib (56 mg/m2) and dexamethasone (Kd56) vs bortezomib plus dexamethasone (Vd); and the ARROW study compared (once-weekly carfilzomib [70 mg/m2]-dexamethasone [Kd70] vs carfilzomib (27 mg/m2) plus dexamethasone (Kd27).
The median progression-free survival and median overall survival were superior with KRd27 in ASPIRE (24.1 vs. 15.9 months and 36.4 vs. 26.2 months) and Kd56 in ENDEAVOR (18.7 vs. 6.6 months and 33.6 vs. 21.8 months), whereas Kd70 resulted in improved median progression-free survival in ARROW (10.3 vs. 6.6 months). Across all studies, adverse events of grade 3 or higher occurred as expected based on the primary study outcomes. Patients with frailty status experienced consistent efficacy and safety while receiving KRd27, Kd56, and weekly Kd70.
“Frail, elderly patients often receive suboptimal therapies,” noted the authors. “There exist concerns about prescribing full doses in frail patients who may experience adverse reactions without additional efficacy benefits. However, these concerns should be balanced by the potential for enhanced efficacy with higher treatment doses.”
Disclosure: For full disclosures of the study authors, visit ashpublications.org.