Comparison of Two Induction Therapies for Newly Diagnosed Multiple Myeloma
Francesca Gay, MD, of the University of Torino, Italy, and colleagues compared carfilzomib/lenalidomide/dexamethasone (KRd) and carfilzomib/cyclophosphamide/dexamethasone (KCd) as induction therapies in newly diagnosed patients with multiple myeloma, in the randomized FORTE trial. The safety profile appeared to be acceptable for both regimens, and the rate of very good partial responses was higher with KRd. These findings were presented at the 2017 American Society for Clinical Oncology (ASCO) Annual Meeting (Abstract 8003).
Of an enrolled total of 477 patients, 281 were evaluable at the cutoff date; 94 received KCd and 187 received KRd. Both groups also were treated with high-dose melphalan and autologous stem cell transplantation. In addition, all patients received cyclophosphamide and a peripheral blood stem cell collection following the fourth induction cycle.
Adverse events were primarily hematologic, including thrombocytopenia, neutropenia, and anemia. Nonhematologic side effects included rashes, infections (mainly pneumonia/fever), elevated hepatic enzymes, as well as atrial fibrillation/ischemic heart disease. Patients receiving lenalidomide demonstrated greater grade 3 or 4 rashes and hepatic enzyme elevations. More patients treated with KRd required the immunostimulant plerixafor than did those on KCd (24% vs. 10%).
Despite a higher incidences of adverse events in patients receiving KRd, 74% of these patients reported a very good partial response compared with 61% of KCd patients. Patients in both arms exhibited similar responses to mobilized stem cells.