Dr. Puertas‐Martinez on Carfilzomib and Dexamethasone plus Cyclophosphamide in Multiple Myeloma

Borja Puertas‐Martinez, MD, Hematology Department, Complejo Asistencial Universitario de Salamanca in Salamanca, Spain, discusses the use of carfilzomib (Kyprolis) and dexamethasone with or without cyclophosphamide in patients with relapsed/refractory multiple myeloma.

A phase 2 trial (NCT03336073) randomized patients with relapsed/refractory multiple myelomawho received 1-3 prior lines of therapy to evaluate the efficacy of carfilzomib and dexamethasone with or without cyclophosphamide.

Findings presented at the 19th Annual International Myeloma Society Meeting showed that the addition of cyclophosphamide to carfilzomib and dexamethasone did not generate a progression-free survival (PFS) benefit vs carfilzomib and dexamethasone alone in the overall population, Puertas‐Martinez says.

However, the triplet did provide a PFS benefit in patients who were lenalidomide (Revlimid) refractory, Puertas‐Martinez adds. In this subset of patients, carfilzomib plus dexamethasone and cyclophosphamide produced a median PFS of 19 months, compared with 12 months for carfilzomib and dexamethasone alone, Puertas‐Martinez explains.

However, carfilzomib and dexamethasone with cyclophosphamide generated a lower median overall survival (OS) vs carfilzomib and dexamethasone alone, though this difference was not statistically significant, Puertas‐Martinez adds. The difference in OS could be related to additional toxicity associated with the triplet, though this is still being investigated, Puertas‐Martinez concludes.