Dr Jakubowiak on the Efficacy of KRd Maintenance Therapy Post-ASCT in Multiple Myeloma

“Interestingly, we also saw a benefit [with KRd maintenance over lenalidomide maintenance in terms of] overall survival [in addition to the progression-free survival benefit].”

Andrzej Jakubowiak, MD, PhD, a professor of medicine and the director of the Myeloma Program at University of Chicago Medicine, discussed the notable efficacy data from the phase 3 ATLAS study (NCT02659293) of carfilzomib (Kyprolis), lenalidomide (Revlimid), and dexamethasone (KRd) vs lenalidomide maintenance alone for the treatment of patients with multiple myeloma who have already received autologous stem cell transplantation (ASCT).

During the 22nd Annual International Myeloma Society Meeting and Exposition, Jakubowiak presented findings from ATLAS which showed that patients in the intention-to-treat (ITT) population who received KRd (n = 92) experienced a median progression-free survival (PFS) of 72.8 months compared with 37.3 months in the lenalidomide monotherapy arm (n = 88; HR, 0.46; 95% CI, 0.30-0.70; P = .0002). The respective 4-year PFS rates were 67.5% and 38.0%. These findings confirmed previously published interim PFS results, he noted.

Jakubowiak noted that beyond the PFS benefit, KRd also showed an advantage over lenalidomide monotherapy in terms of overall survival (OS). Specifically, the median OS in the investigational arm was not reached compared with 82.2 months in the lenalidomide monotherapy arm (HR, 0.49; 95% CI, 0.26-0.90; P = .023). This finding was somewhat unexpected, as the study was not specifically powered for other end points beyond PFS, he added.

Additional findings showed that patients with high-risk disease in the investigational arm (n = 22) experienced a median PFS of 59.1 months compared with 29.7 months in this subgroup of the control arm (n = 18; HR, 0.54; 95% CI, 0.22-1.15; P = .13). A significant PFS benefit with KRd vs lenalidomide alone was also reported in patients with standard-risk disease (HR, 0.43; 95% CI, 0.26-0.69; P < .001).

Regimen’s producing both a PFS and OS benefit are generally rare in multiple myeloma, Jakubowiak concluded.