Alternative to Lenalidomide ID’d for Maintenance in Multiple Myeloma

WEDNESDAY, Feb. 1, 2023 (HealthDay News) — For patients with newly diagnosed multiple myeloma after induction treatment and autologous stem cell transplantation, maintenance therapy with carfilzomib, lenalidomide, and dexamethasone may be better than lenalidomide alone, according to a study published online Jan. 12 in The Lancet Oncology.

Dominik Dytfeld, M.D., Ph.D., from the Poznan University of Medical Sciences in Poland, and colleagues conducted an interim analysis of a multicenter, randomized, phase 3 trial conducted in 12 academic and clinical centers. Participants were aged 18 years or older with newly diagnosed multiple myeloma and had completed an induction regimen followed by autologous stem cell transplantation. Participants were randomly assigned to receive maintenance therapy with carfilzomib, lenalidomide, and dexamethasone or lenalidomide alone (up to 36 cycles; 93 and 87 patients, respectively).

The researchers found that the median progression-free survival was 59.1 and 41.4 months in the carfilzomib, lenalidomide, and dexamethasone group and in the lenalidomide alone group, respectively (hazard ratio, 0.51). The most common grade 3 and 4 adverse events were neutropenia, thrombocytopenia, and lower respiratory tract infections (48 versus 60 percent; 13 versus 7 percent; and 8 versus 1 percent, respectively). Overall, 30 and 22 percent of patients in the carfilzomib, lenalidomide, and dexamethasone group and in the lenalidomide alone group reported serious adverse events.

“To our knowledge, this study is the first randomized phase 3 trial suggesting superiority of an alternative maintenance therapy to lenalidomide alone,” the authors write.

Several authors disclosed financial ties to pharmaceutical companies, including Amgen and Celgene (Bristol Myers Squibb), which manufacture carfilzomib and lenalidomide, respectively, and funded the trial.

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