Rx Combo Slowed Multiple Myeloma

Carfilzomib added to lenalidomide and dexamethasone may slow multiple myeloma progression

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) When it comes to treating multiple myeloma, three medications may be better than two.

A new study found that adding carfilzomib to a standard two-medication treatment — composed of lenalidomide and dexamethasone — may slow down the blood cancer multiple myeloma.  Multiple myeloma is a blood cancer that forms in a type of white blood cells called plasma cells.

In the past two decades, researchers have found medications that combat this disease. One standard regimen for myeloma treatment has been the combined use of lenalidomide (brand name Revlimid) and dexamethasone (DexPak, Dexasone, Diodex, Hexadrol and Maxidex). The authors of this new study found that adding carfilzomib (brand name Kyprolis) to this therapeutic duo had a greater impact at slowing the disease than the other two medications alone.

“Patients taking three drugs — carfilzomib, lenalidomide and dexamethasone — stayed free of disease progression for 26 months on average,” said lead study author A. Keith Stewart, MB, a Mayo Clinic oncologist in Scottsdale, AZ, in a press release. “No one has reported anything like this before for relapsed multiple myeloma.”

Multiple myeloma affects about 1 in 143 people in the US, according to the American Cancer Society. This cancer is diagnosed mostly in people older than 65.

A total of 792 patients with relapsed myeloma took part in the study. Myeloma responds to treatment, but it is currently incurable. Patients with relapsed myeloma have had successful treatment that gave them a period of remission (when the cancer is not growing). Eventually, however, the myeloma returns (called a relapse).

Patients were randomly assigned to either a regimen with all three treatments or one with just the lenalidomide and dexamethasone. Dr. Stewart and colleagues analyzed patients' responses to the treatments between 2010 and 2014.

These researchers observed that adding adding carfilzomib to the standard treatment of lenalidomide and dexamethasone extended remission by 8.7 months more than the two-medication treatment. That was a total of 26.3 months with the three medications versus 17.6 months with the two.

The number of patients who displayed no detectable disease was three times greater among carfilzomib-takers than in the other group.

Adding carfilzomib increased the response rate as well — with 87.4 percent responding to treatment, compared to about 67 percent of those taking the two medications.

“Importantly, patients on the three-drug cocktail also reported a better quality of life despite a higher intensity of treatment,” Dr. Stewart said. “Survival of multiple myeloma has almost doubled over the last decade, and the very positive outcomes from use of the three-drug combination will likely further improve outcomes."

Lenalidomide is used to enhance the immune system cells that identify and attack cancer cells. Dexamethasone is a type of steroid that helps the immune system control inflammation. Carfilzomib targets and attacks myeloma cells.

This research was published online Dec. 6 in the New England Journal of Medicine. It was presented Dec. 7 at the annual meeting of the American Society of Hematology in San Francisco.

Onyx Pharmaceuticals, an Amgen subsidiary, funded the study. Dr. Stewart consulted with Onyx but did not received compensation. He has also served as a consultant with Celgene, Novartis, Bristol-Myers Squibb and Sanofi Aventis.

Review Date: 
December 8, 2014
Last Updated:
December 9, 2014