Multiple Myeloma Coverage from Every Angle

Triplet Regimens Compared in Newly Diagnosed Multiple Myeloma: ENDURANCE Trial

By: Joseph Fanelli
Posted: Monday, October 5, 2020

According to findings from the phase III ENDURANCE trial presented in The Lancet Oncology, a regimen of carfilzomib, lenalidomide, and dexamethasone (KRd) did not improve progression-free survival for patients with newly diagnosed multiple myeloma, compared with the standard-of-care triplet regimen of bortezomib, lenalidomide, and dexamethasone (VRd). In fact, KRd also was associated with more toxicity, noted S. Vincent Rajkumar, MD, of the Mayo Clinic, Rochester, Minnesota, and colleagues.

“The VRd triplet regimen remains the standard of care for induction therapy for patients with standard-risk and intermediate-risk newly diagnosed multiple myeloma and is a suitable treatment backbone for the development of combinations of four drugs,” the authors concluded.

In this open-label study, the authors enrolled 1,087 patients with newly diagnosed multiple myeloma who were ineligible for or did not intend to have immediate autologous stem cell transplantation. Of those enrolled, 524 were treated with VRd, and 545 were treated with KRd.

At a median follow-up of 9 months, the median progression-free survival with KRd was 34.6 months, compared with 34.4 months with VRd. The median overall survival was not reached in either group.

The most common grade 3 or 4 treatment-related nonhematologic adverse events were fatigue (6% in both treatment groups), hyperglycemia (4% in the VRd cohort and 6% in the KRd group), diarrhea (5% vs. 3%), peripheral neuropathy (8% vs. less than 1%), dyspnea (2% vs. 7%), and thromboembolic events (2% vs. 5%). Two patients died of treatment-related events in the VRd group, and 11 patients died of treatment-related events in the KRd group.

Disclosure: For full disclosure of the study authors, visit

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