Synapse - Bortezomib, lenalidomide and dexamethasone (VRd) vs carfilzomib, lenalidomide and dexamethasone (KRd) as induction therapy in newly diagnosed multiple myeloma

Bortezomib, lenalidomide and dexamethasone (VRd) vs carfilzomib, lenalidomide and dexamethasone (KRd) as induction therapy in newly diagnosed multiple myeloma Journal Article

Authors:	Tan, C. R.; Derkach, A.; Nemirovsky, D.; Ciardiello, A.; Diamond, B.; Hultcrantz, M.; Hassoun, H.; Mailankody, S.; Shah, U.; Maclachlan, K.; Patel, D.; Lahoud, O. B.; Landau, H. J.; Chung, D. J.; Shah, G. L.; Scordo, M.; Giralt, S. A.; Lesokhin, A.; Usmani, S. Z.; Landgren, O.; Korde, N.
Article Title:	Bortezomib, lenalidomide and dexamethasone (VRd) vs carfilzomib, lenalidomide and dexamethasone (KRd) as induction therapy in newly diagnosed multiple myeloma
Abstract:	Lenalidomide and dexamethasone with bortezomib (VRd) or carfilzomib (KRd) are commonly used induction regimens in the U.S. This single-center, retrospective study evaluated outcomes and safety of VRd and KRd. Primary endpoint was progression-free survival (PFS). Of 389 patients with newly diagnosed multiple myeloma, 198 received VRd and 191 received KRd. Median PFS was not reached (NR) in both groups; 5-year PFS was 56% (95%CI, 48–64%) for VRd and 67% (60–75%) for KRd (P = 0.027). Estimated 5-year EFS was 34% (95%CI, 27–42%) for VRd and 52% (45–60%) for KRd (P < 0.001) with corresponding 5-year OS of 80% (95%CI, 75–87%) and 90% (85–95%), respectively (P = 0.053). For standard-risk patients, 5-year PFS was 68% (95%CI, 60–78%) for VRd and 75% (65–85%) for KRd (P = 0.20) with 5-year OS of 87% (95%CI, 81–94%) and 93% (87–99%), respectively (P = 0.13). For high-risk patients, median PFS was 41 months (95%CI, 32.8–61.1) for VRd and 70.9 months (58.2-NR) for KRd (P = 0.016). Respective 5-year PFS and OS were 35% (95%CI, 24–51%) and 69% (58–82%) for VRd and 58% (47–71%) and 88% (80–97%, P = 0.044) for KRd. Overall, KRd resulted in improved PFS and EFS with a trend toward improved OS compared to VRd with associations primarily driven by improvements in outcome for high-risk patients. © 2023, The Author(s).
Keywords:	adult; controlled study; event free survival; treatment outcome; aged; middle aged; retrospective studies; major clinical study; overall survival; lenalidomide; paresthesia; drug efficacy; drug safety; drug withdrawal; antineoplastic agent; progression free survival; bortezomib; multiple cycle treatment; multiple myeloma; antineoplastic combined chemotherapy protocols; opiate; dexamethasone; autologous stem cell transplantation; retrospective study; high risk patient; dyspnea; chronic disease; disease severity; thorax pain; heart infarction; weakness; atrial fibrillation; chemotherapy-induced peripheral neuropathy; induction chemotherapy; pericarditis; carfilzomib; gabapentin; duloxetine; pregabalin; pulmonary hypertension; comparative effectiveness; Common Terminology Criteria for Adverse Events; humans; human; male; female; article; ecog performance status
Journal Title:	Blood Cancer Journal
Volume:	13
ISSN:	2044-5385
Publisher:	Nature Publishing Group
Date Published:	2023-07-25
Start Page:	112
Language:	English
DOI:	10.1038/s41408-023-00882-y
PUBMED:	37491332
PROVIDER:	scopus
PMCID:	PMC10368661
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85165684915&doi=10.1038%2fs41408-023-00882-y&partnerID=40&md5=4991a1c35def1abd722f0fcb51c37231
Notes:	Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PubMed and PDF -- MSK corresponding authors are Carlyn Tan and Neha Korde -- Source: Scopus