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Newly Diagnosed Myeloma: Phase II Trial of Carfilzomib and Dexamethasone

By: Celeste L. Dixon
Posted: Monday, April 1, 2019

Never before evaluated in newly diagnosed multiple myeloma, the two-drug combination of carfilzomib and dexamethasone (Kd) was effective in a phase II trial. In fact, it seems to be the most active two-drug combination yet tested in this setting, according to the findings published in the American Journal of  Hematology, comparable with highly active three-drug induction combinations. Almost all participating patients achieved at least a partial response.

Initial author Peter A. Forsberg, MD, of the University of Colorado School of Medicine, Aurora, and colleagues wrote that Kd’s “relatively narrow toxicity profile” is significant. Most toxicities that occurred were low grade, and “certain common toxicities, particularly hematologic adverse events, [occurred] at a very low rate.” For these reasons, induction with Kd may be a particularly appealing option for patients who have cytopenias at diagnosis. The doublet is already known to have significant activity in patients with relapsed and refractory multiple myeloma.

The single-arm study involved 72 patients newly diagnosed with multiple myeloma. Toxicity was one endpoint; another was overall response rate, which was 90%. Five patients achieved a complete response or better. Carfilzomib was administered in 2 dosing cohorts: 20/45 mg/m2 in the first 25 patients and 20/56 mg/m2 in the rest.

A third endpoint was the impact of carfilzomib on CD34-positive stem cell collection yield. Kd induction “allowed for sufficient stem cell yields and appears to enhance the mobilization process,” wrote Dr. Forsberg and co-investigators. They reminded, however, that given the trial’s design, progression-free and overall survival endpoints with the doublet will not be available until disease progression and survival data are mature.

Disclosure: The study authors’ disclosure information may be found at onlinelibrary.wiley.com.



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