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Carfilzomib-lenalidomide-dexamethasone vs lenalidomide-dexamethasone in relapsed multiple myeloma by previous treatment

Autores: Dimopoulos, M. A.; Stewart, A. K. ; Masszi, T.; Spicka, I.; Oriol, A. ; Hajek, R.; Rosinol, L. ; Siegel, D.; Mihaylov, G. G.; Goranova Marinova, V. ; Rajnics, P. ; Suvorov, A.; Niesvizky, R.; Jakubowiak, A.; San Miguel Izquierdo, Jesús; Ludwig, H. ; Ro, S. ; Aggarwal, S.; Moreau, P.; Palumbo, A.
Título de la revista: BLOOD CANCER JOURNAL
ISSN: 2044-5385
Volumen: 7
Número: 4
Páginas: :e554
Fecha de publicación: 2017
Resumen:
Carfilzomib, a proteasome inhibitor, is approved as monotherapy and in combination with dexamethasone or lenalidomidedexamethasone (Rd) for relapsed or refractory multiple myeloma. The approval of carfilzomib-lenalidomide-dexamethasone (KRd) was based on results from the randomized, phase 3 study ASPIRE (NCT01080391), which showed KRd significantly improved progression-free survival (PFS) vs Rd (median 26.3 vs 17.6 months; hazard ratio (HR) = 0.690; P = 0.0001). This subgroup analysis of ASPIRE evaluated KRd vs Rd by number of previous lines of therapy and previous exposure to bortezomib, thalidomide or lenalidomide. Treatment with KRd led to a 12-month improvement in median PFS vs Rd after first relapse (HR 0.713) and a 9-month improvement after >= 2 previous lines of therapy (HR 0.720). Treatment with KRd led to an approximate 8-month improvement vs Rd in median PFS in bortezomib-exposed patients (HR 0.699), a 15-month improvement in thalidomide-exposed patients (HR 0.587) and a 5-month improvement in lenalidomideexposed patients (HR 0.796). Objective response and complete response or better rates were higher with KRd vs Rd, irrespective of previous treatment. KRd had a favorable benefit-risk profile and should be considered an appropriate treatment option for patients with 1 or >= 2 previous lines of therapy and those previously exposed to bortezomib, thalidomide or lenalidomide.